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 PHYSICAL AND MEDICAL TREATMENT 
 
 CHILDREN. 
 
 .BY 
 
 WILLIAM P. DEWEES, M. D., 
 
 LATE PROFESSOR OF MIDWIFERY 1ST THE UNIVERSITY OF PENNSYLVANIA; MEMBER OF 
 THE AMERICAN PHILOSOPHICAL SOCIETY; OF THE ROYAL MEDICAL SOCI- 
 ETY OF DENMARK; OF THE PHILADELPHIA MEDICAL SOCI- 
 ETY; LECTURER ON MIDWIFERY, &C. &C. 
 
 SEVENTH EDITION, WITH CORRECTIONS, &c. 
 
 PHILADELPHIA: 
 
 CAREY, LEA & BLANCHARD. 
 
 183& 
 

 Eastern District of Pennsylvania, to wit: 
 
 BE IT REMEMBERED, that, on the sixth day of November, in the fifty- 
 first year of the Independence of the United States of America, A. D. 1826, 
 William P. Dewees, M. D., of the said district, hath deposited in this office the 
 title of a book, the right whereof he claims as Author, in the words follow- 
 ing-, to wit: — 
 
 " A Treatise on the Physical and Medical Treatment of Children. By Wm. P. 
 Dewees, M. D., late Professor of Midwifery in the University of Pennsyl- 
 vania; Member of the American Philosophical Society; of the Royal Me- 
 dical Society of Denmark; of the Philadelphia Medical Society; Lecturer 
 on Midwifery, &c. &c. Seventh Edition, with Corrections, &c." 
 
 In conformity to the Act of the Congress of the United States, entitled, "An 
 Act for the Encouragement of Learning, by securing the Copies of Maps, 
 Charts, and Books, to the Authors and Proprietors of such Copies, during the 
 times therein mentioned"— And also to the Act, entitled, "An Act supplemen- 
 tary to an Act, entitled, * An Act for the Encouragement of Learning, by se- 
 curing the Copies of Maps, Charts, and Books, to the Authors and Proprietors 
 of such Copies, during the times therein mentioned,' and extending the bene- 
 fits thereof to the arts of designing, engraving, and etching Historical and other 
 Prints." 
 
 D. CALDWELL, 
 
 Clerk of the Eastern District of Pennsylvania. 
 
 &IUGGS & CO., PRINTERS. 
 

 o 
 
 p 
 
 TO 
 
 THOMAS C. JAIES, M. D. 
 
 PROFESSOR OF MIDWIFERY 
 
 IN THE UNIVERSITY OF PENNSYLVANIA, 
 
 THIS WORK 
 
 IS MOST RESPECTFULLY, AND AFFECTIONATELY INSCRIBED, 
 
 v 
 
 BY HIS FRIEND, 
 
 \ 
 
 THE AUTHOR. 
 
 PHILADELPHIA, 
 
 January, 183J. 
 

TABLE OF CONTENTS. 
 
 BOOK I 
 
 PART I. 
 
 Chap. I. Of Marriage .... 
 
 Sect. I. Of the Period of Life 
 II. Of Constitution 
 
 III. Of Predisposition 
 
 IV. Of the immediate State of Health 
 II. Of the Conduct of the Mother during Pregnancy 
 
 III. Of the Influence of the Imagination 
 
 IV. Of the Indulgence of Temper . 
 
 V. Of the Food proper for Pregnant Women 
 
 VI. Of the Conduct to be observed during Labour 
 
 VII. Of the Conduct during the Month 
 
 VIII. Observations enforcing the foregoing Rules . 
 
 IX. Of the Treatment of the Nipples . 
 
 ^ X. Of the Mother suckling her Child 
 
 XI. Of Physical Injuries to the Child 
 
 XII. Of Moral Injuries .... 
 
 XIII. Of Dressing the Child 
 
 Sect. I. Of Washing 
 
 II. Of the Dress of the Child . 
 
 III. Of the Belly-Band 
 
 IV. Of the General Dress of the Child 
 V. Of Changing the Child . 
 
 XIV. Of Feeding the Child in the Month 
 
 I XV. Of Observances towards the Mother during the 
 
 Month . 
 XVI. Of the Duties of the Mother after the Month . 
 XVII. Recapitulation of the Instructions given to the Fe 
 male during Pregnancy, Labour, and Confine 
 ment, as well as Rules for the general Manage 
 ment of the Child during the Month 
 XVIII. Of the Nursery .... 
 
 PART II. 
 
 Chap. I. First Period * 
 
 Sect. I. Of Crying 
 II. Of Sleep 
 
 Page 
 
 ±7 
 
 17 
 21 
 
 22 
 23 
 25 
 34 
 41 
 42 
 45 
 47 
 48 
 53 
 56 
 63 
 69 
 69 
 70 
 7$ 
 80 
 83 
 88 
 89 
 
 93 
 96 
 
 102 
 108 
 
 120 
 121 
 
 123 
 
 III. Of the Necessities of the Child . 125 
 
VI TABLE OF CONTENTS. 
 
 * . Page 
 
 Chap. II. Of the Air . . ; . .126 
 
 Sect. I. Of temperature . . 137 
 
 II. Of Fashion . . .140 
 
 III. Of Exposure and " Hardening " 141 
 
 III. Of Food 150 
 
 Sect. I. Causes which may render it improper • 
 
 for the mother to suckle her Child 151 
 
 IV.* Of the Meconium, and its Management . 153 
 
 V. Of the proper Nourishment for- the Child . 159 
 
 VI. Of Partial or Artificial Nursing . . 162 
 
 Sect. I. First Means, or where the Mother 
 
 suckles her Child . . 162 
 
 II. Second Means . . .170 
 
 III. Third Means . . . 180 
 
 VII. Second Period. Of Weaning . . . 192 
 
 Sect. I. On the Part of the Mother . 192 
 
 II. On the Part of the Child . .195 
 
 A— Of the Teeth . . 195 
 
 B—Of the Child's HeaUh . 197 
 
 III. Of the Season of the Year . 198 
 
 VIII. Of Teething . . . . .201 
 
 Sect. I. Of the Phenomena of Teething 204 
 
 II. Of Second Dentition . . 208 
 
 IX. Of, the Food proper after First Dentition and \ 
 
 Weaning . . . . .211 
 
 X. Are there Substances in common Use, absolutely 
 
 hurtful to Children p . . . 220 
 
 Sect. I. Of Fruit in general, and of Fresh 
 
 Fruits 222 
 
 II. Of Dried Fruits . .*L 227 
 
 XI. Of Exercise . . . . .228 
 
 Sect. I. Of Carrying in the Arms . 228 
 
 II. Of Walking . . .233 
 
 III. Of other Modes of Exercise . 235 
 
 A — Riding in a Carriage . 235 
 
 B — Riding on Horseback . 237 
 
 C — Of Games and Exercises of' y 
 
 various kinds . . 238 
 
 &—Dumb-Bells . . 239 
 
 XII. Of Bathing and Cleanliness . . . 240 
 
 XIII. Of Dress "..... 249 
 
 Sect. I. Of the Form of the Garments . 250 
 
 II. Of the Quantity and Quality of 
 
 Clothing . . . 251 
 
 PART III. 
 
 Chap. I. Observances from Second Dentition to Puberty . 254 
 
TABLE OF CONTENTS. 
 
 Vll 
 
 BOOK II. 
 
 OF THE DISEASES OF CHILDREN. 
 
 Chap. I. 
 
 II. 
 
 III. 
 
 IV. 
 
 V. 
 
 VI. 
 
 VII. 
 
 VIII. 
 
 IX. 
 
 ,x. 
 
 XI. 
 
 XII. 
 XIII. 
 
 Of the Want of Respiration 
 
 Of Syncope, or Fainting 
 
 Of the Meconium . 
 
 Of Jaundice 
 
 Of Erysipelas 
 
 Of the Retention of Urine 
 
 Of Aphthse 
 
 Of Colic 
 
 Of Ophthalmia 
 
 Of Ulceration of the Mouth . 
 
 Of the Inflammation and Swelling of the Breasts 
 
 of new-bom Children 
 Of Dentition ..... 
 
 Of tlie Diseases arising from Dentition 
 
 Sect. I. Of Eruptions' 
 
 A — Crust a Lactea 
 B — Tooth Rashes 
 
 1. Strophulus Confertus 
 
 2. — lntertinctus . 
 
 3. — Albidus . 
 
 4. Volaticus 
 
 \ 5. Candidus 
 
 Of Sore Ears 
 XIV. Of Tongue-Tie .... 
 
 1. Of the Adventitious Tying of the Tongue . 
 
 2. Of the Original Conformation of the Frse- 
 
 num rendering the Tongue too short 
 
 3. Of th\ swallowing of the Tongue, and He- 
 
 morrhage ..... 
 XV. Of Bleeding from the Navel-string . 
 XVI. Of Ulceration, or Imperfect Healing of the Navel 
 Treatment in the First Situation . 
 Second Situation 
 Third Condition 
 XVII. Of Hydrocele 
 XVIII.- Of Umbilical Hernia . 
 XIX. Of Inguinal Hernia 
 XX. Of Abscess of the Hip Joint . 
 XXI. Of Abscess within the Ear 
 XXII. Of Adhesion of the Labia Pudendi 
 
 XXIII. Of Diabetes 
 
 XXIV. Of Incontinence of Urine 
 
 Page 
 
 1 275 
 282 
 287 
 289 
 293 
 300 
 302 
 310 
 314 
 319 
 
 321 
 322 
 331 
 331 
 331 
 338 
 '338 
 339 
 341 
 342 
 342 
 343 
 345 
 S*5 
 
 346 
 
 347 
 349 
 351 
 351 
 352 
 352 
 352 
 353 
 355 
 356 
 359 
 361 
 364 
 365 
 
Vlll 
 
 Chap. XXV. 
 XXVI. 
 
 XXVII. 
 
 XXVIII. 
 
 XXIX. 
 
 XXX. 
 
 XXXI. 
 
 XXXII. 
 
 XXXIII. 
 
 XXXIV. 
 
 XXXV. 
 
 XXXVI. 
 
 XXXVII. 
 
 XXXVIII. 
 
 XXXIX. 
 
 XL. 
 
 XLI. 
 
 TABLE OF CONTENTS. 
 
 Of Constipation 
 Of Vomiting 
 
 Idiopathic . " 
 
 Sympathetic . 
 Of Diarrhoea . . . 
 
 Sect. I. Feculent 
 II. Bilious 
 
 III. Mucous 
 
 IV. Chylous 
 V. Lienteric 
 
 VI. Chronic Form of Diarrhoea 
 VII. Of the Treatment 
 Of Cholera Infantum . 
 Of Ho oping -Cough 
 Of Cynanche Tonsillaris 
 Of Cynanche Parotidsea, or Mumps 
 Of Croup . 
 
 Of Worms 
 
 Of Scarlet Fever 
 Of 
 
 Of Measles 
 
 Of Nettle Rash 
 
 Of Burns .... 
 
 Of Prolapsus Ani 
 
 Of the Whitlow . 
 
 Of Discharges from the Vagina . . 
 
 Of Scurfiness of the Head 
 
 A Translation of the Prescriptions 
 
 A Glossary for explaining Technical Terms 
 
 Index . 
 
 Page 
 
 367 
 369 
 370 
 
 371 
 375 
 375 
 381 
 387 
 389 
 391 
 396 
 407 
 415 
 427 
 448 
 452 
 454 
 481 
 498 
 506 
 515 
 519 
 523 
 525 
 528 
 529 
 531 
 534 
 537 
 
PREFACE. 
 
 We thought it would be useful, before we treated of the dis- 
 eases of children, to give a summary of the physical treatment 
 of children. This subject, though deserving of consideration, is 
 almost new in this country. In treating of this important j-^rt 
 of education, we have consulted some of the best authorities on 
 the subject, and have also endeavoured to make our own ex- 
 perience useful. By appealing to experience and reason, we 
 have tried to avoid speculation; and have not permitted our- 
 selves to be seduced into the difFuseness of Jean Jacques Rous- 
 seau, nor to rest contented with the limited, though generally 
 correct views of Faust. We have endeavoured to condense 
 most of the important points, which reason has dictated, or ex- 
 perience has sanctioned, within as narrow a compass as ap- 
 peared consistent with perspicuity. 
 
 The physical treatment of children, in its details, is almost 
 infinitely diversified; for custom, prejudice, and speculation, 
 have imposed regulations, which, in their extent, are neither 
 sanctioned by reason nor experience. The first declares its in- 
 fluence, by the perpetuation of restraints upon the body and 
 limbs of the passive child, by which it is moulded to the form, 
 that caprice, or hypothesis judges best, for its future health, or 
 proportions — hence, the continuance of tKe unnatural practice 
 of " swaddling." ^^i*^^ 
 
 We cannot but regard as one of the greatest improvements in 
 modern physical education, the now almost universal abandon- 
 ment of swathes, and stays. This unnatural practice will, doubt- 
 less, be hereafter looked .upon as " a tale of the olden time," 
 when fable usurped the place of truth; for we are not certain, 
 even at this moment it will obtain belief, that, in Great Britain, 
 half a century ago, this custom was almost universal. Dr. Bu- 
 2 
 
PREFACE. 
 
 chan informs us, (Advice to Mothers, p. 108,) that he was very 
 instrumental in abolishing this cruel, and absurd practice. His 
 Inaugural Dissertation was upon this subject; and when he re- 
 commended a loose and easy dress for children newly born, he 
 had not only to contend against the force of custom, and the 
 stubbornness of prejudice, but also against the opinion of the 
 " Medical Faculty of the University of Edinburgh," itself. 
 
 It may not be amiss to state, for the information of those who 
 have heard of" swaddling," but who are ignorant of its mean- 
 ing, that this practice consists in entirely depriving the child of 
 the use of its limbs, by enveloping them in an endless length of 
 bandage, so as to make them not unaptly resemble billets of 
 wood. By this means, the skin was sometimes excoriated; the 
 fle^sh compressed almost to gangrene ; the circulation nearly ar- 
 rested, and the child left without the slightest power of motion. 
 
 Its little waist was surrounded by stays of such stiffness, and 
 such strictness of application, as to forbid flexion, either back- 
 ward or forward, or, indeed, motion of any kind. Its head was 
 compressed into such a form as the fancy of the midwife might 
 suggest ; and its shape maintained, by properly adjusted pres- 
 sure, by means of bandages. In fact, the talents of the mid- 
 wife were estimated at this time, by her dexterity in the appli- 
 cation of swathes, rather than by her professional acquirements. 
 When the child was completely dressed in its bandages, it but 
 too nearly resembled the form of an Egyptian mummy ; and, 
 like its prototype, might, it is said, have been safely thrown any 
 where, as the swathing would protect it from being injured by 
 such rudeness. In a word, it had no resemblance to any thing 
 living : its frequent but unavailing cries alone determined it to 
 be human. . 
 
 The second shows its influence, in the almost entire confor- 
 mity to usage, though a more rational mode is constantly pre- 
 senting itself for imitation; — hence, the continuance of customs, 
 however pernicious and preposterous, by foreigners, among 
 those who are more rational in their habits and manners. 
 
 The third, from preconceived notions, prescribes rules, for 
 that which it would be desirable to attain, rather than that 
 which is practicable; hence, the many Eutopean notions of Jean 
 Jacques Rousseau. It would, therefore, seem, that this important 
 part of education consists rather in usage, than in regulations 
 based upon reason and experience; for, were these to be the 
 
PREFACE. XI 
 
 foundation, much less difference would be found in the education 
 of children than at present exists. 
 
 The education we are now considering, consists in the deve- 
 lopment of the physical and moral powers of man ; consequently, 
 that scheme which does this in the most perfect manner, must be 
 the best — but much discrepancy prevails, in what the scheme 
 should consist. We make no pretensions to originality ; nor 
 shall we boast of any superiority, in our present endeavour, over 
 the systems which have gone before us; we merely hope, that 
 the result of long observation, and experience, will not be alto- 
 gether unavailing. 
 
 It will be seen, by the arrangement of our subject, that it is 
 our opinion, that the physical treatment of children should begin, 
 as far as may be practicable, with the earliest formation of the 
 embryo: it will, therefore, necessarily involve the conduct of the 
 female even before her marriage, as well as during the period of 
 pregnancy. It will also be obvious, that the various contingen- 
 cies which may affect her, as well in health, as in disease, must 
 also exert an influence upon the foetus. To the mother, then, 
 we have addressed a few directions, that she may be enabled to 
 contribute to the healthful stamina of her child, about to be born. 
 
 We would not, however, positively say, with some, that every 
 man is nothing more nor less, than that which his mother has 
 made him; nor that to her care, alone, he is indebted for a vigo- 
 rous constitution ; nor to her neglect that he must solely attribute 
 a feeble frame : yet we dare advance, that very much depends 
 on her either to ensure the one, or prevent the other. 
 
 To ensure the first of these objects, and to prevent the other, 
 it would seem evident that the woman herself must possess 
 health; and, at all times to preserve this, is not only highly desi- 
 rable, but it becomes an imperious duty, if she have a suspicion 
 she is about to become a mother; for now she has committed to 
 her trust the future welfare of a being, to whom she should be 
 united by the most tender and endearing of ties. 
 
 Let her, then, in early life convince herself, that an awful re- 
 sponsibility is attached to the title of " mother;" and that, if she 
 enter into the holy state of marriage with heedless haste ; and 
 without weighing the nature and importance of the duties she 
 
Xll PREFACE. 
 
 voluntarily imposes on herself, she will but too certainly dis- 
 charge them without pleasure, if not with reprehensible neglect. 
 
 As the influence of the maternal constitution upon the embryo 
 must be admitted, we have thought it proper to suggest, how 
 much a woman owes it to herself, as well as to society, that she 
 enter not into the marriage state while labouring under such dis- 
 qualifications as will be sure to entail debility, or disease upon 
 her offspring; we have, therefore, directed our first chapter to 
 this object. 
 
 In such horror did 'the ancients hold such marriages, that, un- 
 der the pretext of serving the public weal, the offspring were 
 •often condemned to death, without feeling or remorse. 
 
 The cruel and severe laws of Lycurgus, forbade the parent to 
 take charge of his child, or to educate him according to his own 
 mode; it was always submitted to the inspection of a jury of 
 elders, whose decision was final. Should the child be found 
 lively, robust and well-shaped, it was maintained at the public 
 expense, and had a certain portion of the public wealth assigned 
 it; and from that moment, it became the property of the repub- 
 lic; but if, on the other hand, it were found feeble, deformed, or 
 crippled, it was by the same power, without mercy or hesitation, 
 consigned to death, by throwing it into the Apothetes. 
 
 There is no fact better established, than that the stamina* of 
 offspring almost exclusively depends upon the good health of the 
 parents ; and that upon the original healthy dispositions of the 
 child will the success of well directed physical education very 
 much depend; for upon the judicious application of physical agents 
 healthy development takes place; and by their misapplication, 
 the soundest stamina may be converted into never-ending debili- 
 ty, or pitiable helplessness. 
 
 How important, then, is good conduct, both before and after 
 marriage, to the formation of healthy stamina. And how espe- 
 cially essential and proper, are certain observances of the mo- 
 ther during pregnancy, that she may ensure desirable dispositions 
 to her infant ; at least, so far as she is capable of imparting them 
 during that period. And, on the other hand, how reprehensible 
 
 * We employ this tqrm in the singular, from usage, and not from the rules of 
 grammar. 
 
PREFACE. . X1H 
 
 is that heedless selfishness of the mother, who, for a momentary 
 gratification, neglects the opportunity of imparting health and 
 vigour to her offspring. 
 
 To constitute a mother, in the best sense of the term, much 
 more is required than giving birth to progeny — it requires quali- 
 ties both rare and estimable ; it exacts a patient endurance of fa- 
 tigue, and anxious solicitude, as well as a submission to priva- 
 tions, which nothing will render supportable, but that love of off- 
 spring which a kind Providence has so generally, and so deeply 
 implanted in the female heart. Thus, the toil and danger of 
 child-birth; the fatigue and anxiety of nursing, and the respon- 
 sibility of education, exclusively for a time devolve upon the fe- 
 male. Can the attempt, then, to diminish the first, to relieve the 
 second, and divide the third, be unacceptable? 
 
 Is it not both unfortunate and unjust, that the responsibility 
 and care of early education should so exclusively devolve on 
 the mother? For it is every way sufficiently severe upon her 
 to superintend the concerns of her establishment, if it be an ob- 
 ject that these shall be well and economically managed, with- 
 out the burden and perplexity of educating her children. 
 
 It is time, then, that some changes were made, which would 
 tend to the relief of the over-burdened mother ; and this can be 
 most profitably done, by the father partaking in this arduous and 
 interesting duty. This would not only contribute to the relief 
 of the mother, but would command a conformity from the child, 
 that would be highly useful to its future welfare. 
 
 Besides, the father from his education and studies,- is, for the 
 most part, better qualified to direct and enforce a proper sys- 
 tem of physical education. But, unfortunately, at present, every 
 thing connected with the nursery and education, is "voted a bore," 
 by the modern fine gentleman; and the physical treatment of his 
 children is a duty he would feel almost disgraced to perform. 
 Not so felt a Cato, an Augustus, a Henry the Fourth, or a Mon- 
 taigne : they felt it worthy of their most serious regard. 
 
 The table of contents will nearly explain our plan: we have 
 commenced with considerations on marriage ; we have given di- 
 rections for the conduct of the mother during pregnancy, labour, 
 and the month of confinement ; pointed out what is proper for 
 
XIV PREFACE. 
 
 the child during that period ; attempted to convince the mother 
 it is her duty to suckle her child ; or, in case she cannot, what 
 is the next best course ; considered^ what is the best method of 
 clothing, dressing, feeding, and exercising the child ; explained 
 the nature of our atmosphere ; shown in what its purity, and its 
 deterioration depend ; in a word, we have attempted to deter- 
 mine the influence of physical agents upon the constitution of 
 the being, from its embryo existence, to that state of develop- 
 ment, called puberty. . 
 
THE PHYSICAL* TREATMENT 
 
 OF 
 
 CHILDREN. 
 
OF 
 
 THE PHYSICAL. TREATMENT 
 
 OF 
 
 CHILDREN 
 
 BOOK I. — PART I. 
 
 CHAPTER I. 
 OF MARRIAGE. 
 
 1. Before we detail the duties of the married woman, either 
 as regards herself, or the treatment of her children, we feel it 
 proper to say a few words upon the subject of marriage, as it 
 must have a strong bearing upon the health of offspring. We 
 shall consider this subject under the following heads: — 1st, the 
 most proper period to both sexes for its consummation ; 2dly, the 
 respective constitutions of the individuals; 3dly, their disposition 
 to disease ; 4thly, their immediate state of health. 
 
 Sect. I. — Period of Life. 
 
 2. It is notorious, that the development of the body is succes- 
 sive, and requires a definite period for its completion; consequent- ' 
 ly, certain functions cannot be performed, in the best manner, 
 until full development — this rule applies as well to the female, 
 as to the male. It is also familiar to observation, that when any 
 viscus is prematurely or inordinately urged to action, that it is 
 followed by the imperfection of the product dependent upon the 
 part thus stimulated, as well as entails upon the organ so exer- 
 cised, debility, if not premature decay. 
 
 3. From this it will follow, that too early marriage is never 
 to be advocated ; since it will materially influence the health, 
 and well being, of offspring. This fact is no less conspicuous 
 
 3 
 
18 
 
 OF MARRIAGE. 
 
 in the inferior animals, than it is certain in its consequences in 
 man. We would, therefore, not only say, that marriage should 
 not take place until the body is healthily and completely deve- 
 loped, but also that there should have been, on the part of the 
 male, the most scrupulous eontinency, that the great object of 
 marriage, (the propagation of healthy children,) should not be 
 defeated : this cannot be too strongly insisted upon, however lit- 
 tle it may be availing. The female is always supposed to be so 
 after the establishment of the catamenia, the enlargement of the 
 breasts, and general development of the body. 
 
 4. It would be difficult to rigorously fix the period by years, 
 at which the body becomes fully expanded : since, original sta- 
 mina, physical and moral education, climate, mode of life, &c. 
 will have their influence ; but we may with much certainty fix 
 it, in this climate, at between the twenty-third and twenty-fifth 
 years, for the male ; and from the nineteenth to the twenty-first 
 years, for the female.* We are informed by Tacitus, that the 
 ancient Germans never married until the twenty-fourth or twen- 
 ty-fifth year of their age, and were as continent before its con- 
 summation, as the females, to whom they were united ; in con- 
 sequence of which, they acquired a size and strength, that ex- 
 cited the astonishment, of even the Romans. 
 
 5. It has frequently excited the surprise, as well as provoked 
 the reproach of foreigners, that the females of this country lose 
 their beauty so early, especially when compared with the females 
 of Europe, and particularly those of Great Britain. The cause 
 of this hasty decay must be principally sought for in our very early, 
 or rather premature marriages; but we confess that climate has 
 
 * The following curious table, constructed by Dr. Granville from an examina- 
 tion of eight hundred and seventy-six cases in lying-in hospitals, &c, is the first 
 ever submitted to females to exhibit their chances of marriage at various ages. 
 
 Years of 
 
 age. 
 
 Years of age. 
 
 Years of age 
 
 3 at 
 
 13 
 
 85 
 
 at 
 
 22 
 
 7 
 
 at 31 
 
 11 at 
 
 14 
 
 59 
 
 at 
 
 23 
 
 5 
 
 at 32 
 
 16 at 
 
 15 
 
 53 
 
 at 
 
 24 
 
 7 
 
 at 33 
 
 43 at 
 
 16 
 
 36 
 
 at 
 
 25 
 
 5 
 
 at 34 
 
 45 at 
 
 17 
 
 24 
 
 at 
 
 26 
 
 2 
 
 at 35 
 
 67 at 
 
 18 
 
 28 
 
 at 
 
 27 
 
 
 
 at 36 
 
 115 at 
 
 19 
 
 22 
 
 at 
 
 28 
 
 2 
 
 at 37 
 
 118 at 
 
 20 
 
 17 
 
 at 
 
 29 
 
 
 
 at 38 
 
 86 at 
 
 21 
 
 9 
 
 at 
 
 30 
 
 1 
 
 at 39 
 
 It is a curious fact, that if a woman marry at twenty-one or twenty-two, and is 
 placed under precisely similar circumstances, for the following fifteen years, as 
 women at fourteen, fifteen and nineteen, marrying at that age, may be supposed 
 to be under, she will produce the same number of children as the latter would, 
 though the party marry eight years later. 
 
PERIOD OF LIFE. 19 
 
 also a certain, though a more limited agency. Though we are 
 far from discouraging early marriages, yet we are decidedly op- 
 posed to'premature ones. By early marriage we would wish to 
 be understood, such as may take place so soon as the body has 
 received its final expansion ; and that time, we have just fixed, 
 as a general rule, at nineteen, or a little more, for the female; 
 and twenty-three, and a little upwards, for the male. By prema- 
 ture ones, we mean those which happen before the system has 
 received its ultimate development, be this period when it may;* 
 — and this should be the more insisted on, as it would appear from 
 the calculations of Dr. Granville, in the note just referred to, 
 that neither the woman herself nor soeiely lose by a proper de- 
 lay — so that it is best to do so, both morally and politically. 
 
 6. It will readily be seen, that no precise or absolute rules 
 based upon the lapse of years, can be laid down ; since the body 
 of both male and female may be precociously expanded, or may 
 be unusually morbidly retarded. In the first instance, the period 
 we have assigned may be anticipated with safety; but in the 
 second, it would be wise to extend it. Thus, oftentimes in India, 
 females become mothers at ten ; while in Lapland they rarely 
 give evidence of w 7 omanhood until eighteen; consequently, the 
 women of India would be on the wane, did they wait for the 
 limit at which it would be proper for a Lapland woman to marry; 
 and the Lapland woman could not support the contingencies of 
 marriage, did she attempt to regulate it by the usage of India. 
 
 7. The evil consequences resulting from precocious unions in 
 this country, are familiar to every body — they are not limited to 
 the diminished vigour, and shortened life of the male ; nor to 
 the faded beauty, the blasted health, and the premature old age 
 of the female ; but are extended to their innocent offspring, on 
 whom they have perhaps entailed a diminutive stature, debility 
 of body, and imbecility of mind ; or have handed down to them, 
 strong predisposition to consumption, rickets, scrofula, &c. It 
 is therefore of the utmost consequence that parents do not con- 
 sign their children to inevitable ill health, by consenting, or some- 
 times by urging them to too early marriages ; and on the part of 
 
 * This should not be confounded with the mere growth of the body, for we have 
 seen instances where the osseous and muscular system has been unusually early de- 
 veloped, while the uterine has been very imperfectly so — hence, the error of con- 
 founding the necessity of its functions with the ordinary development of other 
 parts of the body. See Treatise on the Diseases of Females, art, "Amenorrhea" 
 
20 OF MARRIAGE. 
 
 the children themselves, that they do not yield themselves up to 
 almost inevitable destruction, (especially the female,) by antici- 
 pating the eligible moment for marriage consummation. 
 
 8. We are, however, strong advocates for early marriages, 
 (agreeably to our definition of them ;) we are persuaded of the 
 importance of both their moral and political tendency; and we 
 think they should be encouraged, wherever there is a rational 
 expectation of both these great ends being answered. 
 
 9. The consequences of ill-assorted marriages were well known 
 to the ancients, and were strictly forbidden by the Greek legis- 
 lators ; and though things have not proceeded to such length in 
 this country, as to require the interference of the laws, it is ne- 
 vertheless sufficiently common to make a caution upon the point 
 proper. Should no attention be paid to compatibility, the ob- 
 vious and most desirable objects of marriage will be defeated, 
 and one great source of health and longevity destroyed ; for it is 
 a fact, no less important than well established, that a well regu- 
 lated marriage, contributes largely to these two great ends. It is 
 declared by Huffland, that all those who have attained great age, 
 were married even more than once, and generally at a late period 
 of life ; and that there is no instance of a bachelor attaining a 
 great age. We may give two remarkable instances of longevity, ' 
 where marriage was often repeated : one in Thomas Parr, of 
 England, who attained to one hundred and fifty-two years, and 
 was married several times : and the other in De Longville, of 
 France, who lived until he was one hundred and ten years old, 
 and married ten wives; his last, he married in his ninety-ninth 
 year, and she bore him a son when he was in his hundred and 
 first. 
 
 10. It seems agreeable to all observation, that better constitu- 
 tions are perpetuated to offspring by men advanced in life, where 
 the physical powers have been well preserved by moderate and 
 proper use, than by young men who have been prodigal of them ; 
 for it is oftentimes better to be old in years, than in constitution. 
 
 11. Though we have said that men advanced in life may have 
 healthier offspring than the man who too early tests his prowess, 
 or the one who has been too prodigal of his powers, we are not 
 advocates for the union of old age to blooming youth. On the 
 contrary, we are entirely convinced, that none so completely 
 fulfil their duties to society, as those who unite themselves as 
 soon as the proper development of body, and well established 
 
CONSTITUTION. 21 
 
 health, will justify their union. Yet we are equally persuaded 
 of the truth of what we have just observed ; namely, that a man 
 advanced in years may have every requisite firmness of consti- 
 tution, to justify a union'; while a young man, who may have a 
 natural feebleness of constitution, a strong predisposition to dis- 
 ease, or its actual existence, or a debility from overtaxed powers, 
 may be altogether ineligible to such a consummation. 
 
 Sect. II. — Of Constitution. 
 
 12. It is not alone sufficient for the best purposes of marriage, 
 that the body has received its final development, either on the 
 part of the male or the female; since all the functions of the 
 body may be disturbed, by either feeble organization, disease, or 
 accident. When, then, the male and female, or either, has suf- 
 fered in constitution, it is not to be expected they can impart to 
 offspring that which they themselves do not possess. It should, 
 therefore, always be a consideration in a marriage contract, that 
 both parties be of sound health and constitution. 
 
 13. We are aware in many instances it may be said, that hale, 
 healthy-looking children belong to parents of feeble constitution : 
 but we must be cautious how we admit this as militating against 
 our position ; since, such appearances are by no means conclu- 
 sive of the goodness of health, or the soundness of constitution. 
 We have many times seen children of robust appearance from 
 parents of feeble health ; but we do not recollect a single in- 
 stance, where such children attained an age much beyond man- 
 hood — old age was out of the question. Indeed, it would seem, 
 in many instances, that children of such parents most frequently 
 give an early promise of future health ; but it is illusory — as it is 
 never or but very rarely realized. Like fruit, that attains its ma- 
 turity prematurely, it looks fair to the eye : but cancer is lurking 
 at the core. In the early part of the lives of the children of whom 
 we are now speaking, a rapid, but morbid development of the 
 body takes place ; every function is inordinately performed ; and 
 when the constitution is confirmed in appearance by such a dis- 
 play of health, it is but hastening to decay. Let us not then be 
 deceived by such appearances ; and when we are choosing for 
 our children, let us select such as give a rational reliance upon 
 the soundness of their constitution. 
 
22 OF MARRIAGE. 
 
 Sect. III. — Predisposition to. Disease* 
 
 14. There are numerous diseases, or rather a disposition to 
 them, which do not show themselves for many years after birth, 
 or until they are called into action by some exciting cause, either 
 suddenly or gradually applied; such diseases are gout, madness, 
 scrofula, consumption, &c. Those who may inherit such predis- 
 positions, may for many years enjoy good health ; and may not 
 be led to suspect a cause to be lurking in their systems, which, 
 when called into action, shall, but too soon, destroy such flatter- 
 ing expectations. It therefore becomes a point of duty in pa- 
 rents to investigate the tendency to hereditary complaints, be- 
 fore they connect their children with those, who can give but a 
 temporary security against the most painful, afflicting, irremedia- 
 ble, or suddenly fatal diseases. 
 
 15. We hold it selfish at least, if not dishonest, for either sex 
 to marry under such predispositions, when from the knowledge, 
 of the diseases of their forefathers, there was every reason to an- 
 ticipate a perpetuation of them. Who has not witnessed the 
 most deplorable consequences of such unions? — and who, after 
 witnessing them, would not deprecate their continuance, or far- 
 ther propagation? This subject is one of much importance; for 
 some cf the best interests of society are involved in it ; and every 
 one is concerned in diminishing the evils spoken of, by prevent- 
 ing marriages which can promise nothing but the extension of 
 the most dreadful diseases.* We have seen but too many in- 
 stances of the perpetuation of the maladies above enumerated, 
 not to feel desirous to arrest them, by recommending the two 
 only means by which they can be either prevented or mitigated ; 
 namely, by judicious and well assorted marriages, and a well 
 conducted physical education. 
 
 * We have been much pleased with the observations of Dr. Reid upon this 
 important point, as they convey and enforce our own sentiments. " Nothing can 
 be more obvious, than that one who is aware of a decided bias in his pwn person 
 towards mental derangement, should shun the chance of extending, and of per- 
 petuating, without any assignable limit, the ravages of so dreadful a calamity. No 
 rites, however holy, can, under such circumstances, consecrate the conjugal 
 union. In a case like this, marriage itself is a transgression of morality. A man 
 who is so situated, in incurring the risk of becoming a parent, involves himself in 
 a crime; which may not improbably project its lengthened shadow, a shadow too 
 which widens in proportion as it advances over the intellect, and the happiness of 
 an indefinite succession of beings.— Med. Ckirur, Rev. for July* 1830, p. 90. 
 
IMMEDIATE STATE OF HEALTH. 23 
 
 16. By the first means, we may stop, in a great measure, the 
 hereditary transmission of predisposition, by selecting such sub- 
 jects as shall be free from constitutional taint; or, at least, we 
 may diminish by this plan the risk of such occurrence, if we 
 cannot ensure exemption from it. We may also do much good 
 by preventing altogether the union of such as may have these 
 tendencies; or diminish the evils in a degree, when nothing bet- 
 ter can be done, by not admitting to this union more than one 
 of a party who may have hereditary taints. 
 
 17. By the second, much may be effected; by invigorating 
 the general system, so as to render it less susceptible to exciting 
 causes: by attention, while conducting this education, to strength- 
 en the particular parts, which may be predisposed to disease. 
 But of this more by and by. 
 
 Sect. IV. — Of the Immediate State of Health. 
 
 18. By the immediate or actual state of health, we would wish 
 to be understood, that condition of the system in which either 
 of the above named diseases is absolutely developed. It might, at 
 first sight, appear strange, that we should notice this state of the 
 system ; as every one would seem to be apprized of it, and, con- 
 sequently, the person labouring under it would not be considered 
 eligible by any one, for the married state. But this is not ex- 
 actly so ; as we find that every kind of artifice is resorted to, to 
 hide this condition from those most interested in the knowledge 
 of it, — hence, the frequency of marriages, under such circum- 
 stances. 
 
 1 9. Besides, it but too frequently happens, that this foreknow- 
 ledge is entirely disregarded by the persons most concerned — 
 this may arise from several causes: 1st, to a want of proper feel- 
 ing for the consequences of such diseases, when extended to off- 
 spring; 2dly, to a hope of an escape from their consequences, as 
 sometimes happens; 3dly, to an ignorance of their nature, and 
 of the risk of their propagation ; 4thly, to a disgraceful selfish- 
 ness, where fortune or beauty is concerned. 
 
 20. In Europe, they have such dread of the perpetuation of 
 these diseases, (with, perhaps, the exception of gout,) that the 
 inquiry is frequently made in the higher ranks of society, before 
 the marriage contract is signed, whether either of these diseases 
 actually exist, or whether the parties be liable to them by here- 
 
24 OF MARRIAGE. 
 
 ditary descent ; and we are informed, that marriages have been 
 frequently broken off, and even at a late period, when it was 
 discovered, on the side of either party, that scrofula, consump- 
 tion, or madness, had existed, or was actually existing, in any 
 member of the family. 
 
 21. It is not, however, predisposition to disease, or its actual 
 existence, that exclusively disqualifies the parties for marriage — 
 or that may entail feebleness of body or mind upon offspring ; for 
 there are others, equally certain, though less notorious to common 
 observation ; such are the habits of general dissipation, or habi- 
 tual intoxication. The first appears to have most effect upon 
 the body, the latter upon the mind ; therefore, a woman should 
 not unite herself to a man who labours under either, if it be 
 known; and the laws should protect her by granting a divorce, 
 if it occur after. 
 
 22. In this country, the vice of intoxication is more common 
 than any other ; but, unfortunately for the poor female, it bdt too 
 often occurs only after marriage; and against this the laws make 
 no provision — she is then doomed, in her own person, to all the 
 horrors which await the vice ; and her children are to be the in- 
 heritors of feeble constitutions : or, what is perhaps worse, the 
 predisposition to derangement of mind, or, the perpetuation of 
 the same vice. 
 
 23. On the part of the female, certain physical disabilities may 
 exist, which would render her ineligible for the married state; 
 these should neither be concealed, nor passed over lightly ; since, 
 with a knowledge of them, it would be dishonest towards the 
 man she may marry, as well as fatal to herself. We would, 
 therefore, recommend to a woman who may be deformed, to ab- 
 stain from marriage, as she may purchase the title of wife at too 
 high a price ; and we would advise such as may be disposed to 
 cancerous affections, or such as may have one in an active 
 state, to refrain from this state, as she can promise herself no 
 advantage from this ceremony, as regards the melioration of her 
 disease ; for with it she will linger through continued ill health 
 and pain, become a source of misery and expense to a husband, 
 whose patience and resources may too easily be exhausted, and 
 thus fall an earlier victim than from disease alone. 
 
 24. We would also recommend the female not to put off this 
 ceremony to too late a period of life, when she can with pro- 
 
IMMEDIATE STATE OF HEALTH. 25 
 
 priety do otherwise ; unless she be content to endure more than 
 ordinary suffering from child-bearing, and become regardless of 
 the pleasure of seeing her children settled in life before she leaves 
 the world, by even the common contingency of age. Women 
 who have passed the thirty-fifth year of life, might, perhaps, do 
 best to submit to farther procrastination, and permit the period 
 of child-bearing to pass before they marry. (See par. 4, 5.) 
 
 25. Upon the same principle, in part, would we caution the 
 very young girl not to enter into this state; as she, like the wo- 
 man who may have waited too long, is liable to severe suffering 
 from labour. In the woman too far advanced, the parts con- 
 cerned in parturition seem to forget, in a degree, their offices; 
 while, in the too young female, they have not entirely or per- 
 fectly acquired the capacity. It is lamentable to see the num- 
 ber of sacrifices of this kind : we have seen but too many females 
 marry at fifteen or sixteen, become mothers at great hazard, and 
 their career of life run, at thirty years. They die of premature 
 old age, at this early period. These facts are too well known 
 to be disputed; and nature seems to have contended for preroga- 
 tive in both instances. Shall we then become voluntarily blind, 
 by shutting our eyes against her obvious intentions? Do not 
 these facts emphatically declare, there is a time best fitted for 
 marriage ? This time we shall fix at nineteen for the earliest, 
 and thirty for the latest best periods. (Par. 4, 5.) 
 
 26. We do not, however, mean to say, the period fixed for the 
 earliest may not, without any very great risk, be anticipated a 
 little; or that the second may not safely be exceeded — we mean 
 merely to insist, that the periods just designated are best as ge- 
 neral rules; for it is but general rules we can lay down upon this 
 subject. 
 
 CHAPTER II. 
 
 OF THE CONDUCT OF THE MOTHER DURING PREG- 
 NANCY. 
 
 27. When we consider the delicacy and uncertainty of the 
 attachment between the ovum and the uterus in the early months 
 
 4 
 
26 OF THE CONDUCT OF THE MOTHER 
 
 of pregnancy, and the facility with which this union may be de- 
 stroyed, we cease to wonder, that abortion should so frequently 
 take place ; but, at the same time, we are taught to acknowledge 
 the care that is required for its prevention. 
 
 28. Could we excite in the female a proper dread of this ac- 
 cident and its consequences, by representing the facility of re- 
 currence ; the difficulty of interrupting its course when a habit 
 is established ; and the terrible train of evils in its suite, we 
 should make her careful how she incurred the risk to which so 
 severe a penalty is attached. 
 
 29. Should she, however, disregard the physical evils which 
 so uniformly attend habitual abortion, and set at naught mere 
 bodily suffering, she surely could not resist the appeal which a 
 neglect of proper care constantly makes to her moral sense : she 
 would most certainly question her right to destroy the fruit of a 
 union she is bound to hold sacred, by conduct of her own, when 
 it was completely in her power to have prevented abortion by 
 the observance of a few rules, which neither require severe pri- 
 vations, nor very rigid conformities. 
 
 30. To us, who are familiar with the consequences which fol- 
 low repeated abortion, it is truly a matter of surprise, mingled 
 with regret, that females should so entirely shut their eyes against 
 them, and brave the evils, numerous and serious as they are, 
 rather than submit to a properly regulated plan for the interrup- 
 tion of their progress, or to avoid the causes which may produce 
 them. We have but too often seen the fairest promises of health 
 and long life blasted, by disregarding the friendly warnings, a 
 first or second accident of this kind had given ; and we feel it an 
 imperious duty to proclaim the nature of those evils which are 
 sure sooner or later to follow, in hope it may awaken the female 
 to a sense of her danger, and excite her to a due regard for her 
 future welfare. 
 
 31. To the fine lady by profession, we are well aware this ap- 
 peal would be in vain ; or at least, it will not challenge her at- 
 tention, until her health is either about to be destroyed, or very 
 seriously injured ; or, when there is but an uncertain chance of 
 recovery. 
 
 32. The consequences of repeated abortion are, first, a bad 
 state of Leucorrhcea ; secondly, immoderate flow of the catamenia, 
 attended very often by the expulsion of coagula ; their too fre- 
 quent returns; or that distressing condition of this discharge 
 
DURING PREGNANCY. 27 
 
 called dysmenorrhea, or painful menstruation ; thirdly, dyspep- 
 sia, with all its terrible penalties ; fourthly, scirrhi and cancers ; 
 besides many other evils of minor importance. The catalogue 
 here exhibited is not the sportings of the imagination ; it has but 
 too real a foundation, as every practitioner of experience can 
 safely testify. 
 
 33. To prevent the consequences above stated, (32,) the preg- 
 nant woman must scrupulously avoid, 1st, such motion as shall 
 unduly exercise her muscles; as too long walks, especially in 
 such weather as will endanger her falling ; or as shall overheat 
 her, as dancing in very hot weather ; hastily running up stairs ; 
 lifting heavy weights, &c. ; 2nd, all such as shall take her mind 
 by surprise, if we may so term it, as unpleasant or dangerous 
 sights ; 3d, all such as shall inordinately hurry her circulation, 
 as heated rooms, or stimulating liquors, &c; 4lh, all such as shall 
 embarrass the intestinal canal, or too severely tax the powers of 
 the stomach ; as flatulent vegetables, too great a quantity even 
 of proper food, or any quantity taken at improper seasons, as 
 late suppers, &c. ; 5th, all such as shall give too frequent motion 
 to the bowels ; as brisk or drastic purgatives; or such as shall too 
 much retard their motion, as the unnecessary use of laudanum, 
 or the unnatural use of chalk, or disobeying the proper calls of 
 nature, &c. ; 6th, all such as shall make too severe and partial a 
 pressure upon the chest, and abdomen ; as tight lacing, &c. ; 7th, 
 all such as shall increase the irritability of the system; as the 
 immoderate use of strong tea, coffee, opium or other narcotics; 
 and the too long indulgence of repose in warm feather beds; 8th, 
 all such as shall too exclusively occupy the mind ; as severe 
 study, night watching, &c. &c. 
 
 34. But let not the mother believe she completely discharges 
 her duty, or that she gives the best possible chance to her off- 
 spring, by merely escaping from a miscarriage. In this opinion 
 she would certainly not be supported either by facts or reasonings 
 for it is well known to those who are best acquainted with the 
 subject, that the proper circulation and nutrition of the foetus, 
 may, by the improper or heedless conduct of the mother, be im- 
 paired, though the foetus itself may not be destroyed. Of this we 
 have abundant proof in the cases of those who narrowly escape 
 from this accident, and who have had repeated threafenings ; 
 therefore it behooves her, as a rational and an accountable being, 
 as far as possible, to avoid every risk of provoking abortion. She 
 
28 OF THE CONDUCT OF THE MOTHER 
 
 must not flatter herself, because she has not miscarried, that she 
 has done no injury to the fruit of her womb. How many in- 
 stances can almost every mother call to mind, of offspring born 
 feeble and emaciated, and continued to be so, or with difficulty 
 recovered when the cause might be traced to some impropriety 
 of conduct on the part of the parent, or to some accident during 
 the period of utero-gestation, which might have been prevented? 
 
 35. We are well persuaded, that much injury has been done 
 by the prevalence of certain vulgar errors upon this subject ; 
 some of which it may be well to examine. It has been handed 
 down from time immemorial, that pregnancy was constantly ac- 
 companied by a plethoric condition of the blood vessels, and that, 
 consequently, there was a returning necessity for blood-letting. 
 And practice has very constantly been made to conform to this 
 hypothesis by the ignorant or designing, and sometimes to the 
 very serious injury of the patient. It is, however, our deliberate 
 opinion, that this state of fulness does not always exist; and 
 when it does, it by no means follows, that it should always be 
 subdued by bleeding. 
 
 36. We are warranted by long experience to declare, that un- 
 less this plethora produce some direct evidence of a mischievous 
 tendency, as headach,pain in the chest, a sense of fulness in the 
 head upon stooping, giddiness, &c, the patient should not have 
 recourse to bleeding, without the express approbation of the 
 physician. And perhaps it would be erring on the safe side to 
 say, that even where the symptoms just enumerated are present, 
 his advice had always better be asked. 
 
 37. To women who are in the habit of miscarrying, this pro- 
 scription of indiscriminate bleeding is particularly important; 
 especially as it is the remedy almost universally resorted to for 
 its relief; than which, in very many instances, nothing can be 
 more preposterous or improper. We know ourselves to be jus- 
 tified in saying, it has very often produced the evil it was in- 
 tended to prevent. 
 
 38. We are happy to avail ourselves of the opinion of the cele- 
 brated Dr. Struve upon this point; and shall quote his own words: 
 " Many erroneously imagine that blood-letting is useful during 
 pregnancy ; hence, mercenary bleeders and imprudent midwives, 
 contribute to support that ill-founded opinion. It is, however, cer- 
 tain that venesection is a remedy which ought not to be resorted 
 to, without the greatest precaution, as the loss of blood may 
 
DURING PREGNANCY. 29 
 
 precipitate a pregnant woman into many dangerous diseases, 
 and even occasion miscarriage. Instances of this kind have oc- 
 curred in my own practice; and! have known ladies who have 
 unfortunately been subject to successive abortions, because, by 
 the advice of their friends, they regularly submitted to be bled 
 upon such occasions. On their becoming pregnant again, I 
 warned them of the mischief resulting from this practice, and 
 they now'enjoy the happiness of being mothers."* 
 
 39. We admit, without hesitation, that there is a strong ten- 
 dency to fever and fulness during gestation, when there is any 
 cause in operation which may be capable of exciting the system 
 to unusual action, or of filling the blood vessels in an unusual 
 degree ; and it was under this impression that we recommended 
 the cautions suggested above, (33.) For we are fully persuaded, 
 that, for the most part, a proper observance of the rules just re- 
 ferred to, will very frequently render blood-letting unnecessary ; 
 nay, nature institutes nausea, and vomiting, to keep down this 
 excessive fulness. 
 
 40. It must not be inferred, however, from what has just been 
 said, that we are hostile to blood-letting — this is very far from 
 being the case ; we consider ourselves among its warmest advo- 
 cates, if a necessity for its employment really exist : it is against 
 its abuse alone, that we contend. We attach great value to this 
 operation where there is evidence of its necessity; and believe 
 it oftentimes capable of affording relief, where no other remedy, 
 perhaps, would avail ; but of this necessity the experienced and 
 judicious physician should be the only judge ; it should not be 
 left to the decision of every old woman. 
 
 41. From what has just been said, it will appear, that it is not 
 our opinion that pregnancy necessarily renders the use of the 
 lancet proper — it is a vulgar error to suppose so : and as this 
 remedy is sometimes resorted to solely because impregnation has 
 taken place, and this, as stated above (35, 36, 37,) with manifest 
 injury, the sooner this error is corrected the better. We have a 
 hundred times refused our assent to this operation, because there 
 was no one reason for its being resorted to, save that the woman 
 was pregnant. Under such circumstances, it is but little in its fa- 
 vour to say it can do no harm — but even to this trifling recom- 
 mendation, it is not always entitled ; for we can most safely de- 
 
 * Treatise on Physical Education, p. 169. 
 
30 OP THE CONDUCT OF THE MOTHER 
 
 clare, we have frequently known it do serious, and sometimes 
 irreparable mischief. 
 
 42. There is another error of no less moment than the one just 
 combated, and which should also be corrected — namely, the 
 free indulgence of a wayward, or a voracious appetite, because 
 the woman is pregnant : and because, according to common par- 
 lance, she has a child within her to support. This error, or 
 prejudice, in favour of eating largely during pregnancy for the 
 support of the child, is almost constantly at variance with the 
 laws which govern the system at this time. For it almost con- 
 stantly happens that there is a genuine antipathy to animal food 
 during gestation ; and, if taken, it is almost sure to disagree with 
 the patient, and it is hardly fair to suppose, that a substance 
 which disagrees with the mother, will be necessary or accepta- 
 ble to the child. We have often heard this reason given by 
 females, who availed themselves of this condition to gratify 
 their appetites for food, without the smallest regard to conse- 
 quences. Indigestion, colic, cholera morbus, and even convul- 
 sions, have been too often the melancholy consequences of such 
 indulgence. 
 
 43. As this error originates in theory, or hypothesis, it may 
 be well to examine its pretensions; and- if we can show that 
 there is no absolute necessity for taking more food than ordi- 
 nary, we shall be, perhaps, more able to do away the practice. 
 
 44. The demands which the foetus makes upon the mother 
 for the means of its increase, is in proportion to the time of its 
 continuance within the uterus. Now, if we average the weight 
 of new-born children, eight pounds would be excessive for each.* 
 
 * The average we have taken is excessive, perhaps, even for this country, but 
 decidedly so for Europe. — In France, or rather in Paris, at L 'Hospice de la Ma- 
 ternite, the following- table will show a much smaller average in 7077 cases, viz. 
 34 weight from 1 pound to 1£ pound. 
 
 69 2 do. to 2f do. 
 
 164 3 do. to3£do. 
 
 396 4 do. to4£do. 
 
 1317 5 do. to5|do. 
 
 2799 6 do. to6£do. 
 
 1750 7 do. to7£do. 
 
 463 8 do. to 8$ do. 
 
 82 9 do. to9£do. 
 
 3 10 do. to 10£ do. 
 
 Making an average of little more than six pounds. 
 
DURING PREGNANCY. 31 
 
 But, we will assume it to be such : this, of course, will give one 
 hundred and twenty-eight ounces ; the placenta, and membranes, 
 may yield one pound more ; and the liquor amnii, as much ; the 
 account will then stand thus : 
 
 Foetus — 8 lbs. or 128 ounces 
 
 Placenta, and membranes 16 do. 
 Liquor Amnii 16 do. 
 
 Total 160 ounces, or 10 pounds; 
 which will make a daily average demand to less than three- 
 fourths of an ounce, since it requires about two hundred and 
 eighty days for the perfection of the child : now, this quantity is 
 every way too small to require an increase of ingesta, if the 
 quantity taken each day were absolutely and duly weighed; since 
 it is well known to every one, that we habitually take more food 
 into our stomach, than is strictly required for the nourishment 
 of the body,* and, of course, the woman can spare daily, without 
 the slightest disadvantage, the quantity of food necessary to fur- 
 nish three-quarters of an ounce of blood to be applied to the im- 
 mediate purpose of the foetus ; or, in other words, the woman 
 could furnish daily this quantity of blood for the purposes of the 
 child, without feeling the demand to be oppressive; consequent- 
 ly, she cannot require a freer indulgence in food. 
 
 45. Besides, what does nature herself dictate upon this sub- 
 ject? Let us see if she really do not solicit a reduction of the 
 quantity of food, rather than ask for an increase of it. — What 
 happens to almost every woman very soon after impregnation 
 has taken place 1 Nausea and vomiting. Now, do these not most 
 emphatically declare, that the system requires reduction, rather 
 than an increase of fluids 1 or why should this subduing process 
 be instituted ? It certainly cannot be intended for any other pur- 
 pose, since it is not only almost universal, but highly important 
 
 • To show how very much more is taken into the stomach than is required for 
 the purposes of the system, we will extract a note from Friedlander's l'Educa- 
 tion Physique de PHomme, p. 130. "I was informed," says Mr. Friedlander, 
 " by the senator Moscati that he gave a large dinner one day, and had, as a mat- 
 ter of curiosity, every article of the dinner weighed; and he found that one great 
 eater had destroyed one hundred and ten ounces, and that an ordinary feeder had 
 eaten eighty-four ounces." These experiments were made at Milan; he sup- 
 poses not with the utmost exactitude; but they show with great certainty, that 
 very much more is taken, than can possibly be required for the purposes of nou- 
 rishment. 
 
32 OF THE CONDUCT OF THE MOTHER 
 
 when it occurs, as it would seem to add much to the security of 
 the foetus ; for it is a remark, as familiar as it is well grounded, 
 that very sick women rarely miscarry — while, on the contrary, 
 women of very full habits are disposed to abortion, if exempt 
 from this severe, but, as it would seem, important process. 
 
 46. While on the present subject, it may be thought incum- 
 bent that we should say a few words upon that whimsical de- 
 mand, or " longing " for certain substances, the reality of which 
 desire has been doubted by many. No man, however, of ex- 
 perience, we think, will for a moment deny, that, during preg- 
 nancy, there exists occasionally the most wayward appetite, and 
 that even to the extent to which it is said sometimes to urge the 
 unhappy patient. 
 
 47. As regards ourselves, we are entirely convinced of its ex- 
 istence; though we are not altogether prepared to determine the 
 advantages of its gratification, or the evils which might arise 
 from disappointment. We are certainly in possession of some 
 remarkable facts upon this head; and, in many instances where 
 it could not be construed into an attempt to procure " the good 
 things of this world " by sinister means. If women, who are 
 governed by this hallucination of the stomach, were always to de- 
 mand the most grateful or savoury food, there might be some room 
 to suspect the employment of stratagem. But when this morbid 
 and fastidious appetite sometimes demands for its gratification 
 the most disgusting and forbidding articles, we must yield to the 
 belief of the positive existence of " longings." We pretend not 
 to account for this peculiar condition of stomach — we know it 
 only as an attendant upon pregnancy ; and will illustrate it by 
 detailing some remarkable instances of it.* 
 
 48. Mrs. , when not pregnant, had a great horror of eels; 
 
 but, when in this situation, demanded them with an importunity 
 not to be resisted. She, therefore, would not only eat them with 
 
 * We beg, however, that our opinion upon this subject may not be construed 
 into an attempt to foster or perpetuate that waywardness of appetite, or capri- 
 ciousness of selection, of the more stimulating and piquant dishes which are so 
 frequently indulged in by women when pregmnt: we totally disclaim any design 
 to countenance such contemptible stratagems, with a view to exact compliance 
 from an indulgent husband, through the medium of his fears, or his affections. 
 The desires here alluded to, have their origin in mere fastidiousness and affecta- 
 tion — those we believe in, arise from the absolute cravings of a distempered sto- 
 mach. 
 
DURING PREGNANCY. 33 
 
 avidity, but in large and repeated quantities, for the first few 
 months; she would then become indifferent to them, but not 
 averse, until after her delivery. 
 
 49. Mrs. , riding over a common, scented some spoiled 
 
 shad, that had been thrown out; she was instantly so fascinated 
 by their odour, that she obliged her husband to take some of 
 them into his gig; and, as soon as she arrived at home, began to 
 eat of them, raw as they were, and continued to do so daily, un- 
 til they were consumed, though they were extremely offensive 
 to every body else in the house. 
 
 50. Mrs. , in passing through her kitchen, saw a piece of 
 
 bacon skin boiling in the soap kettle ; she had it^ taken out im- 
 mediately, and she ate it with great avidity. 
 
 51. Each of the cases above stated, with the exception of the 
 first, was related to us by the lady herself; in the first, we, our- 
 selves witnessed the eagerness with which the eels were eaten, 
 and received the history of this lady's aversion to them when 
 not pregnant, from ber own mouth. Of the truth of the others, 
 we have not the slightest doubt, as the ladies were of undoubted 
 veracity. It is true, these are extreme cases; but they go to 
 establish the existence of this peculiar appetite, and its indiscri- . 
 minate, and, we may add, of the two last, filthy selections. In- 
 stances of minor enormity are familiar to every body. 
 
 52. In stating our belief in this peculiar, and indomitable 
 craving of the stomach, we admit nothing in favour of the popu- 
 lar opinion, that a disappointment in procuring the desired arti- 
 cle, would be attended with any more serious consequence, than 
 would follow a disappointment of any other kind, at a period 
 when the woman was not pregnant — it might, indeed, nay it very 
 often does, occasion sickness at stomach, a temporary loss of ap- 
 petite, and sometimes vomiting ; but here the evil ceases, as far 
 as we have observed. 
 
 53. Nor do we believe in the influence of the " imagination " 
 upon either the form, colour, or future destiny of the child, how- 
 ever powerfully this faculty may exert itself during gestation — 
 we entirely reject all the reasoning, as well as the appeals to 
 facts, purporting to be illustrative of this wonderful influence. 
 We have, ever since our commencement in business, been atten- 
 tive to this subject ; and we can most conscientiously declare, we 
 have never in a single instance had reason to believe that the 
 imagination had exerted the slightes control upon the foetus in 
 
 5 
 

 34 OF THE INFLUENCE OF IMAGINATION 
 
 utero ; though this is contrary to our early belief upon this sub- 
 ject. 
 
 54. As we feel this to be a subject of high interest to the fe- 
 male, we trust we shall be excused for occupying a few minutes 
 in its consideration ; and the more especially, as we believe, that 
 when the mind is so tenaciously occupied upon the object of its 
 aversion, (as we always find it is,) when an apprehension has 
 been once excited, it may do mischief to the foetus, by impairing 
 its pabulum during gestation, through the medium of the stomach 
 or blood vessels, or both; and hence is connected with the "Phy- 
 sical treatment of children." 
 
 CHAPTER III. 
 
 OF THE INFLUENCE OF IMAGINATION UPON THE 
 FCETUS IN UTERO. 
 
 55. There is no delusion*of the mind during pregnancy, that 
 renders the woman so truly wretched, as the belief, that the ima- 
 gination can exert an injurious control over her child. Should 
 she have an ungratified longing; should she have been disagree- 
 ably surprised, or greatly alarmed ; or, above all, should she have 
 been terrified by some frightful or disgusting object, she at once 
 becomes possessed with the apprehension, that her unborn babe 
 will receive an injury or blemish, similar to that which had ex- 
 cited her aversion, or caused her alarm. She dwells upon this 
 idea with such pertinacity, that she becomes almost a victim to 
 its influence. Her nightly " imaginings " are those of horror ; 
 and the day affords no relief, as her mind teems with prejudices, 
 which are in favour of an influence most earnestly deprecated; 
 and nothing but the delivery of an unblemished child can sooth 
 her agitated feelings, or remove her long-cherished fears. 
 
 56. The origin of this belief, it is true, is coeval with our ear- 
 liest records; but its antiquity should not entitle it to the least 
 force, when this argument alone is employed ; for were this to 
 be a rule, there would be no end to error, however powerfully 
 combated by reason, or opposed by facts. No one circumstance 
 connected with the history of this prejudice, has so effectually 
 contributed to its permanency, as the successful stratagem of Ja- 
 

 
 UPON THE FffiTBS IN UTERO* 35 
 
 cob, to secure to. himself all the " ring-streaked " cattle from the 
 flocks of Laban, as his reward for his faithful services to his sel- 
 fish father-in-law, by placing before them, when they were about 
 to drink, " rods of poplar, and of hazel, and of chestnut tree," on 
 •which were pilled white streaks. v Indeed, this may with much 
 propriety be considered as the origin of this distressing illusion ; 
 and it certainly is one on which the sticklers for this opinion 
 chiefly rely, when strongly opposed by facts, and* reasoning. 
 
 57. We are willing to give every credit to the fact of Laban's 
 cattle becoming " streaked " by Jacob's scheme; as we may un- 
 reservedly believe in it, in that particular instance, without our 
 standing committed for the belief, that this effect continues to 
 be perpetuated to this moment. In the case under considera- 
 tion, we are of the opinion, with many enlightened divines, that 
 there was God's direct interposition in favour of Jacob, against 
 the crafty Laban ; since, as such means would not in general 
 produce similar effects, it is more reasonable to suppose, that he 
 was directed, (in the plan he adopted,) by some divine intimations 
 and rendered successful, if not by a direct miracle, yet by the 
 Lord's giving a new, and uncommon bias to the tendency of na- 
 tural causes. Scott's Family Bible, Gen. Chap. XXX. And 
 this supposition is rendered still more probable, by what follows 
 in verses, 10, 11, 12, and 13, of Chap. XXXI. 
 
 58. If, then, we have rendered it more than probable that the 
 hand of the Lord was in the effect produced by Jacob's mottled 
 
 »rods, we think that much of the feeling upon this subject should 
 be abated, and the, mind be permitted to listen to the suggestion, 
 of reason, and yield to the force of facts. 
 
 59. To remove these apprehensions altogether from the minds 
 of pregnant women, is perhaps impossible; for so fixed are their 
 prejudices, and so cherished are their impressions upon this sub- 
 ject, that it is no longer a matter of reason — it is one almost ex- 
 clusively of feeling. Yet we flatter ourselves the force of this 
 error may be diminished, though not entirely subdued, by argu- 
 ments, based upon the solid foundations of anatomy and physiolo- 
 gy, and from facts, which deserve to be well weighed, before 
 they are rejected. 
 
 60. In the infancy of medical science, the opinion that the 
 imagination exerted an influence on the child in the womb, was 
 implicitly received ; and Hippocrates himself, assisted in the pro- 
 pagation of the delusion. It became not only a popular, but a 
 
36 OF THE INFLUENCE OF IMAGINATION 
 
 fashionable belief; and kings and nobles, with the hope of rea- 
 lizing its efficacy, acted upon the principle ; and even when cer- 
 tainly abused by their wives, they, nevertheless, credited its in- 
 fluence. It was made use of, (honestly we doubt not, at the time,) 
 in some instances, for the protection of the supposed innocent, 
 against the severity of the law, or the indignation of an injured 
 husband. Thus, Hippocrates saved by his testimony a noble wo- 
 man who had been charged, because she had borne a coloured 
 child, (she and her husband both being white,) by alleging that 
 the darkness of its colour was the effect of a picture of an Ethi- 
 opian, which hung in her chamber, and which was often the ob- 
 ject of her contemplation.* And Soranus declares that the ty- 
 rant Dionysius, who was deformed and ill-favoured himself, em- 
 ployed the aid of beautiful pictures, with the hope, that his wife 
 might have comely issue.! 
 
 61. Galen was also opinion, that a picture was sufficient to 
 give a corresponding appearance to the foetus in utero. And 
 Caelius Rhodius informs us, that Fabius Quintillian saved a wo- 
 man from suspicion, after she had brought forth a little negro, by 
 asserting, that the circumstance arose, from her taking great 
 pleasure in viewing the picture of one in her chamber.-)- And 
 it was from the prevalence of this popular belief, that Heliodorus 
 formed the first, and, we may add, one of the most beautiful no- 
 vels in the world. It is called the " Loves of Theagenes and 
 Characlea;" the latter being born white from Ethiopian parents; 
 but the Queen, her mother, had often viewed, during her preg- 
 nancy, the picture of Andromeda, who was painted with a white 
 face ; the sages attributed the white colour of the child to the 
 force of the mother's imagination. 
 
 62. Such notions upon this subject have existed from the ear- 
 liest history of the world ; and such still continue to the present 
 moment; but, with this exception: if cases like those related of 
 Hippocrates and Qnintillian were now to be presented for judi- 
 cial decision, few juries would have sufficient hardihood to at- 
 tribute the effect to the force of the imagination ; yet some not 
 less marvellous and extraordinary stories gain full belief, at the 
 present day, though not entitled to credit, in any superior de- 
 gree. 
 
 <63. The different modes in which the imagination is supposed 
 
 * Turner, p. 169. f Ibid > P- W°- 
 
UPON THE FCETUS IN UTERO. 37 
 
 by its sticklers to affect the fetus, are, 1st, by imposing upon its 
 skin certain resemblances to things on which the fancy has been 
 deeply concerned, or employed ; such as fruit, wine, insects, or 
 animals; 2dly, by the production of additional parts, as two heads, 
 four legs, additional fingers, toes, &c. &c; 3dly, by the absence 
 or destruction of certain parts ; as a leg, or arm, or both ; the 
 want of a head or hand, or foot, or lip, &c. &c. 
 
 64. The alleged effects of the imagination upon the fetus in 
 utero, manifest themselves in one of the three modes just named. 
 (63.) We shall, therefore, say a few words upon each of these 
 heads, respectively; and, first, we shall consider the nature of 
 the connexion which exists between the mother and child, that 
 our objections to the power of the imagination, may be the bet- 
 ter understood. 
 
 65. Anatomy has most satisfactorily proved, that the connex- 
 ion between the mother and child is altogether indirect; and 
 carried on only through the medium of the circulation. It has 
 also shown, there is no nervous communication between them ; 
 or, in other words, that there has never been detected any ner- 
 vous filament of the mother, entering any portion of the fetal 
 system.* . From this wise and all-import.ant arrangement, it fol- 
 lows, that the fetus is not subject to the various and fluctuating 
 condition of the sanguiferous, or to the never-ending changes of 
 the nervous system of the mother; since no direct communication 
 exists between her blood vessels, or nerves, and those of the fe- 
 tus, to impose upon it any alteration that may take place in her 
 system, or to render the child liable through the medium of ner- 
 vous connexion, to her affections. 
 
 66. If the arrangement be such as is now represented, and of 
 the truth of which there cannot be a reasonable doubt, we may 
 ask, how any condition of the arterial, or any affection of the 
 brain and nervous system of the mother, can have an influence, 
 or exert a control, over both these systems of the fetus, which 
 has no direct connexion with the one, nor even an indirect one 
 with the other ? Were this arrangement between mother and 
 child more closely studied, better understood, or more justly ap- 
 preciated, we should hear much less of the influence of the ima- 
 gination of the mother upon the body of her infant ; and one of 
 
 * Sir Everard Home may be cited in opposition to this assertion; but we are 
 of opinion that Sir E. stands alone in this belief: he certainly has not demon- 
 strated them, so as to satisfy any body but himself. 
 
38 OF THE INFLUENCE OF IMAGINATION 
 
 the most agonizing conditions of the human mind would be re- 
 moved from the list of evils attendant upon pregnancy. 
 
 67. No one, so far as we know, has determined at what pe- 
 riod of pregnancy the influence of the imagination ceases ; or, in 
 other words, at which it cannot be successfully exerted — every 
 period of utero-gestation, agreeably to the histories given to 
 prove the powers of imagination, seems alike liable to its control. 
 Now, this admission proves in many instances too much ; for it 
 not only gives to the fancy a generative power, but also an an- 
 nihilating one. Thus, in some cases, an arm, a leg, a thumb, or 
 a toe, is added to*the child ; while, in others, there is a loss of one 
 
 -of these parts. Who has ever detected the severed member, or 
 part, escaping from the womb of the mother, at the birth of the 
 mutilated child 1 Must this not have been observed, had the 
 histories of such cases been a faithful relation of the influence of 
 the imagination'? 
 
 68. Besides, it gives to this power another very extraordinary 
 capacity; namely, the stopping of the blood, after the part has 
 been separated from the body, or limb ; for the child does not 
 die of hemorrhage while in utero, but is absolutely born alive ! 
 We once knew an instance where there was but the stump of an 
 arm, which at the time of birth was perfectly healed, or rather, 
 discovered no evidence that it had ever been a wound ; yet the 
 
 s, mother, in this case, declared herself to have been frightened, tit 
 the sixth month of her pregnancy, by an impudent beggar, who 
 was well known in this city. But what became of the lopped off 
 arm ?-^-what arrested the bleeding ? We certainly did not dis- 
 cover it; nor had we any evidence that there had been a bleed- 
 ing ; for the child was born healthy and vigorous ; and no mix- 
 ture of blood was discovered with the waters. Now, we must 
 ask again, what became of the cast off arm ? or what arrested 
 the bleeding 1 
 
 69. Again, where resemblances have been supposed to be de- 
 tected, between the child and some animal by which the mother 
 had been frightened; and this sometimes even at a pretty ad- 
 vanced period of pregnancy, the power of the imagination must 
 be very wonderful indeed, since, in order that the supposed ef- 
 fect should be produced, it must have new-modelled the head, 
 though the bones of the cranium must have been pretty solid. 
 Thus, Bartholine* informs us, that in the year 1638. a woman 
 
 * Hist. Anat. Cent. 3. Hist. 44, as quoted by Turner. 
 
UPON THE FCETUS IN UTERO. 39 
 
 was delivered of a child in every way well shaped, except the 
 head, which resembled that. of a cat; this deformity was owing 
 to a severe fright which the mother had received, by a cat get- 
 ting into her bed. In this famous case, if the point of resem- 
 blance to the animal by which the mother may have been fright- 
 ened be admitted, it must also be acknowledged, that the head 
 of the child must have been remodelled by some plastic power 
 of the imagination? a circumstance not to be acknowledged by 
 reason, nor to be proved by fact — therefore this case, like many 
 others we could cite, proves too much. 
 
 70. We will not deny that instances occur occasionally of the 
 perpetuation of supernumerary parts, or even marks, in certain 
 families ; such as an additional thumb, or toe, or finger, or a 
 mole, but these cases are not the result of any exercise of the 
 imagination — they are the mere continuance of peculiarity, such 
 as of warts or blotches, the instances of which are numerous — 
 but here the fancy has no agency in their production. 
 
 71. We have been attentive to this subject, as already re- 
 marked, for many years; and commenced our observations un- 
 der the full persuasion of the efficiency of imaginative influence, 
 and abandoned it only because it could not be sustained by facts ; 
 and, at this moment, we are entirely convinced that the fancy 
 exerts no control whatever over the form of the foetus. 
 
 72. We may mention here with much propriety, and we wish 
 we could hope with as much effect, the opinion of the late cele- 
 brated Dr. William Hunter upon this subject. Dr. Hunter used 
 to declare m his lectures that he experimented in a lying-in hos- 
 pital upon two thousand cases of labour, to ascertain this point. 
 His method was as follows : — As soon as a woman was delivered, 
 he inquired of her whether she had been disappointed in any ob- 
 ject of her longing, and what that object was, if her answer were 
 yes. Whether she had been surprised by any circumstance that 
 had given her an unusual shock ; and of what that consisted. 
 Whether she had been alarmed by any object of an unsightly 
 kind; and what was that object. Then, after making a note of 
 each of the declarations of the woman, either in the affirmative 
 or negative, he carefully examined the child ; and he assured his 
 class, that he never, in a single instance of the two thousand, 
 met with a coincidence. He met with blemishes when no cause 
 was acknowledged ; and found none when it had been insisted on. 
 
 73. It must, however, be confessed, that the Dr. owned he met 
 with one case in his private practice, that puzzled him ; and he 
 
40 OF THE INFLUENCE OF IMAGINATION", &C. 
 
 told his pupils, he would merely relate the facts, and leave them 
 to draw their own conclusions. A lady had been married seve- 
 ral years without proving pregnant; but at last she had the satis- 
 faction to announce to her husband that she was in that situation. 
 The joy of the husband was excessive, nay, unbounded ; and he 
 immediately set about to qualify himself for the all-important 
 duty of educating his long-wished- for offspring. He read much, 
 and had studied Martinus Scribelerus with great patience and 
 supposed advantage, and had become a complete convert to the 
 supposed influence of the imagination upon the fetus in utero. 
 He accordingly acted upon this principle. He guarded his wife, 
 as far as in him lay, against any contingency that might affect 
 the child she carried. He, therefore, gratified all her longings 
 most scrupulously; he never permitted her to exercise, but in 
 a close carriage; and carefully removed from her view all un- 
 sightly objects. 
 
 74. The term of gestation was at length completed; and the 
 lady was safely delivered, by the skill of Dr. Hunter, of a living 
 and healthy child; it had, however, one imperfection — it was a 
 confirmed Mulatto. On this discovery being made, the father 
 was at first inexorable; and was only appeased by his dutiful 
 and sympathizing wife calling to his recollection, the huge ugly 
 negro that stood near the carriage door the last time she took 
 an airing, and at whom she was severely frightened !* 
 
 75. Our limits do not permit us to do more ample justice to 
 this subject, by employing additional arguments, or more nu- 
 merous facts, to disprove the agency of the imagination upon the 
 foetus in utero : we shall, therefore, dismiss it; and trust to what 
 we have already said, to awaken the woman to reason, or at 
 least to raise in her a rational doubt of the powers of the im- 
 agination over the fruit of her womb. We must now return 
 to our general subject. 
 
 * " If the imagination or fancy of the parent possessed the influence alleged, 
 it might be destructive of one of the most important ties in society; for the sex 
 might submit to an intercourse with blacks, and could easily conceal from their 
 unsuspecting relatives the adulterous commerce, by the easy expedient, of con- 
 tinually fixing their attention on their husbands, or on objects of a bright colour. 
 If the imagination have the power of producing colours, why should not children 
 be marked with grapes and green gooseberries, as well as with cherries, or red 
 currants? since it may be presumed, that the mother will have as often longed 
 for the one as the other; or why should we meet with deformities among the 
 lower animals, and in plants, even, where the fancy, more especially in the latter, 
 cannot be concerned?" — Campbell's Introduction to Midwifery, &c, p. 115. 
 
OF THE INDULGENCE OF TEMPER, &C. 41 
 
 CHAPTER IV. 
 
 OF THE INDULGENCE AND EXERCISE OF TEMPER, 
 
 &c. 
 
 76. Besides the prohibitions already suggested, there remains 
 to be considered the injurious tendency of an indulgence in un- 
 bridled passion upon the immediate, as well as the future wel- 
 fare of the foetus. The immediate evils which may result from 
 yielding to temper, are convulsions, nervous inquietudes, uterine 
 hemorrhage and, perhaps, abortion. Should this last not occur, 
 the foetus may yet receive such injury, as shall impair its natural 
 stamina, and thus entail upon it a feebleness of constitution as 
 long as it may live. It is a remark long since made, and we 
 believe it to be in perfect conformity with fact, that passionate, 
 and irritable women, are more prone to abortion, than those of 
 an opposite temperament. This fact, alone, points out the neces- 
 sity and importance of resisting those tendencies to anger, which 
 may threaten the life of the mother, or jeopardize the welfare of 
 the child. 
 
 77. Nothing contributes more certainly to the safety, and fu- 
 ture good health of the child, than cheerfulness of mind ; or, at 
 least, equanimity on the part of the mother : — this fact was well 
 known to the ancients ; and they acted upon it, accordingly, by 
 giving great attention to the little wants of the pregnant woman; 
 removing from her all disagreeable and disgusting objects, and 
 constantly presenting her with subjects calculated to excite ad- 
 miration, or to create agreeable impressions on the mind. 
 
 78. The ancient Greeks were firmly persuaded, that the ima- 
 gination of the female had an influence upon the beauty of the 
 child ; hence the practice, as we have already noticed, (35) of 
 constantly providing for the chambers of their wives, the most 
 beautiful specimens of art, such as the figures of Apollo, Bac- 
 chus, Castor and Pollux, Antinous, Narcissus, &c. ; that they 
 might dwell upon their fine proportions, with that complacency 
 of spirit, which a beautiful object is sure to produce. And we 
 believe, if this scheme ever had success, it was by producing a 
 tranquillity of mind, rather than by any formative influence of 
 the imagination. On this principle, also, we would explain the 
 
 6 
 
42 or food. 
 
 observation of Nicolai;* who, while visiting some of the Ca- 
 tholic provinces of Germany, found a number of female faces, 
 divinely beautiful ; especially when engaged in devotional exer- 
 cises : this beauty had most probably been transmitted to them by 
 mothers, who enjoyed the calm and placid sensations, which re- 
 ligious exercises are wont to produce. Here, then, is a powerful 
 motive to preserve equanimity, especially in the earlier months 
 of pregnancy ; as well as to curb a rising and rebellious spirit ; 
 and, at the same time, by an indulgence in innocent pleasure, 
 to chase away the gloom too common to pregnancy. 
 
 CHAPTER V. 
 
 OF THE FOOD PROPER FOR PREGNANT WOMEN. 
 
 79. It is not necessary to give in detail the articles of food 
 which may be proper for the pregnant woman ; especially, as in 
 general they injure more by the quantity, than the quality : a 
 circumstance we have already adverted to, and which need not 
 be repeated. But we must not pass over in silence the highly in- 
 jurious effects of an indulgence in stimulating drinks. 
 
 80. It is a truth that we must not disguise, that a habit of 
 taking too large a quantity, of strong drink is sometimes con- 
 tracted during pregnancy, from a desire to overcome the unplea- 
 sant sensation commonly present at this period by using some 
 cordial or tincture, of high character for this purpose. Every 
 body is aware, how often nausea and other distressing sensations 
 assail the poor female, particularly in the early part of her preg- 
 nancy. To remove this, the good old gossip she may chance 
 to consult, recommends the use of the compound spirit of la- 
 vender, the essence of peppermint, noyeau, &c, which, by af- 
 fording, perhaps, a temporary relief, is again and again resorted 
 to — the quantity is, of course, a little increased at each time, that 
 its effects may be maintained ; and, by and by, the disgusting ha- 
 bit of tippling is too certainly established. 
 
 * Struve. 
 
OF FOOD. 43 
 
 81. No gratification is so dangerous as this: it should be resist- 
 ed from the moment it begins to be importunate ; and a deaf ear 
 should be turned to the dangerous maxim, that " if you want it, 
 it will not hurt you." We have more than once seen health, do- 
 mestic happiness, and even reputation, destroyed, by this danger- 
 ous, and insidious counsel. 
 
 82. It must not, however, be imagined, that the extreme cases, 
 just stated, are essential to constitute its hurtful tendency upon 
 the foetus in utero. Intoxication is, comparatively, a rare vice 
 among females ; yet some are too much in the habit of indulging, 
 during the period of pregnancy, in the use of ardent spirits; and 
 it is wrongly imagined, that any*quantity this side of inebriety is 
 not hurtful ; than which, nothing can be farther from the truth. 
 For every thing that unduly stimulates the system at this time, 
 is highly injurious, by putting both the nervous and vascular sys- 
 tems in an unnatural condition ; consequently, the functions, so 
 important to the welfare of the foetus, are interfered with, or im- 
 perfectly performed — and hence, the children of women, who 
 over-stimulate, or become intoxicated, are always less healthy, 
 and less vigorous, than those of mothers who observe a contrary 
 conduct. 
 
 83. We are persuaded, from what we have seen, that the in- 
 dulgence referred to, is most frequently the result of false impres- 
 sions : impressions, we should be happy to remove, by declaring 
 to the deluded female, that she cannot, from any circumstance 
 connected with her situation, gratify a disposition to take strong 
 liquors, without incurring the risk of destroying her own health, 
 and that of her child.* 
 
 84. From what has been said, it would appear, that the woman 
 has an important duty to perform, during the whole period of 
 utero-gestation ; and, that her offspring may not suffer, in either 
 body or mind by her imprudence, she must most carefully avoid 
 all the causes and circumstances enumerated above. Should she 
 entirely neglect, or but imperfectly observe the rules so impor- 
 tant to the welfare of her child, she becomes culpable in propor^ 
 tion to the neglect. She may entail a frail constitution of body, 
 a perpetual feebleness of mind, or, even fatuity itself; or by ex* 
 
 • We have been made acquainted with a lady, who was determined to bring 
 up her child in a novel way: she insisted that nature gave an appetite for nothing 
 which it was really injurious to the individual to possess, and, with a a view to 
 discover (for the infant cannot indicate its wants,) she resolved to try the child 
 with every substance that she ate and drank herself. She carried this so far, that 
 
44 OF FOOD. 
 
 citing premature labour, she may immolate herself and her off 
 spring. 
 
 85. To a feeling heart, the thought of having destroyed a 
 child by heedlessness, must be productive of the keenest anguish ; 
 and this feeling may be permanent in its effects. We well re- 
 member an elegant, but rather a careless young lady, who be- 
 came a prey, for several years, to a settled melancholy, because 
 she had but too much reason to attribute a premature labour 
 to her own neglect. Even after she became the mother of seve- 
 ral children, she reproached herself for the loss of the first ; and 
 time alone blunted the severity of her self-upbraidings. 
 
 86. Were every female, during pregnancy, to regulate her 
 conduct, as though she were accountable for the health and in- 
 telligence of her child, it would prevent much of the mischief so 
 constantly witnessed ; for, like fruit, properly so called, the child 
 in utero requires a certain amount of care, for its preservation 
 and perfection. 
 
 87. There is another point remains to be spoken of — one that 
 is no less common than injurious ; namely, the attention which 
 pregnant women accord to the chilling and horrifying tales of 
 gossiping beldams. This is of general occurrence, and is extreme- 
 ly injurious; their stories often sink deep into the mind of the un- 
 fortunate hearer, and tinge the remaining portion of her preg- 
 nancy with the most gloomy and melancholy forebodings. We 
 have too often witnessed the evil tendency of this state of mind, 
 not to warn the pregnant woman against indulging in these idle 
 reveries— we once knew abortion very speedily follow a tale of 
 horror; and, frequently, we have known months of sleepless nights 
 succeeds these evil communications. 
 
 88. The following case of abortion, (alluded to above,) is every 
 way illustrative of the influence of ill-directed conversation. 
 Mrs. -n — , in the fifth month of her first pregnancy, complained 
 to an aged relation, of a pain in her right side ; the old woman 
 inquired minutely into its seat and duration, shook her head 
 most significantly, and then said, she was very sorry to hear her 
 complain of that pain, as Mrs. , (a lady who had died a few 
 
 she even forced a large oyster, and a quantity of wine on the child at one time, 
 when it was no more than twenty-four hours old ; and she continued this practice, 
 until it was seized with convulsions, and had nearly died. She then gave her plan 
 up, at the earnest solicitations of her husband, and the repeated advice of the 
 physician: but she was not convinced of the fallacy of her hypothesis, even by this 
 demonstration. 
 
CONDUCT TO BE OBSERVED, &C. 45 
 
 days before,) complained in just the same manner, and it was 
 owing to the after-birth growing fast to (he side, from which the 
 doctor was obliged to tear it, piece by piece, and she died imme- 
 diately after. The lady aborted before the next day. 
 
 89. Having -cursorily considered in the preceding pages the 
 importance of care on the part of the female during gestation, 
 that die best possible chance may be given to the child which 
 she is carrying, we shall merely add a few words upon her con- 
 duct, and that of her attendants, nearly at, and during the pro- 
 gress of labour- 
 
 CHAPTER VI. 
 
 CONDUCT TO BE OBSERVED NEARLY* AT, AND 
 DURING LABOUR. 
 
 90. It would be a gross neglect of duty, should the woman 
 disregard certain rules, which are of high importance to her 
 welfare, and that of her infant at the approach of labour. We 
 shall, therefore, lay them down for her consideration, even though 
 she may not choose to adopt them for her government. 
 
 91. 1st, Let her seek the best possible aid for this anxious 
 moment that the nature of circumstances will permit, both as 
 regards her physician, and her nurse. The propriety of this 
 advice will at once suggest itself, without putting us to the ne- 
 cessity of giving our reasons. 
 
 92. 2dly, Let her not be impelled, by false theories, or by 
 bad counsel, to use too much exercise towards the last period of 
 pregnancy. We are aware this is not popular advice, but it is 
 correct. For, she may be assured, whatever shall produce fa- 
 tigue, will do mischief, by prematurely provoking labour. No 
 animal, (save man,) when left to itself, at this period, disregards 
 the natural instinct : it warns them against unnecessary motion, 
 or exertion, and they, therefore, always indulge in quiet and re- 
 pose. 
 
 93. 3dly, When symptoms warn her of the approach of this 
 important moment, let her not indulge in gloomy forebodings, 
 nor yield to unreasonable fears for the event. But, on the con- 
 trary, let her console herself with the reflection, that death, or 
 
46 CONDUCT TO BE OBSERVED, &C. 
 
 even an untoward accident, is of extremely rare occurrence, 
 when the case is under the direction of a judicious practitioner. 
 
 94. 4thly, When labour has actually commenced, let her not 
 yield to an overweening anxiety to hasten its progress, by taking 
 improper articles of diet or drink ; nor, by repeated marchings 
 in her chamber, hope to promote her general good, by exciting 
 more numerous, or, apparently, more powerful contractions of 
 the womb. Experience has never yet confirmed the propriety 
 of this plan ; and, to us, it appears every way certain that it 
 never can. This is not the place to give our reasons for this 
 belief, but let it be relied upon, that it is entirely confirmed by 
 observation. 
 
 95. 5thly, As the very efforts of labour, however successfully 
 or quickly exerted, must necessarily tend to hurry and disturb 
 the circulation, and thus dispose to fever, let every thing, that 
 can possibly increase the impetus of the blood, be carefully 
 shunned, lest it take place — therefore, the woman must abstain 
 most scrupulously from stimulating victuals or drink, during the 
 progress of labour, under the specious, but false pretext, of sup- 
 porting her strength, that she may the more successfully go through 
 her appointed travail. Let her take the experience of others, on 
 this point, for granted ; and this declares, that an over-charged 
 stomach is always unfavourable, at this time. 
 
 96. 6thly, Let not too much anxiety be indulged for the 
 event; nor too much apprehension be entertained, because the pe- 
 riod of trial is of longer continuance than was anticipated. The 
 patient must recollect, that the duration of labour is not abso- 
 lutely under the control of any one; and that, all things being 
 
 equal, a slow delivery, especially with a first child, is safer 
 than a very rapid one ; and that eventual safety does not, in any 
 degree, depend upon the speed with which this process is per- 
 formed. 
 
 97. 7thly, As it is taken for granted that the woman will em- 
 ploy no one in whom she has not proper confidence, to attend 
 her at this important moment, let her not indulge in any opi- 
 nions that may clash with those of her attendant ; let her yield 
 herself entirely to his directions, for she cannot fail to know less 
 than her physician ; therefore she is not entitled to be her own 
 directress. 
 
 98. 8thly, Let her especially guard against any gust of passion, 
 any childish waywardness, or unprovoked fretfalness, lest the 
 
CONDUCT DURING THE MONTH. 47 
 
 nervous system be thrown out of balance, and hysterical con- 
 vulsions ensue. 
 
 99. 9thly, After she is blessed by the cries of her infant, a 
 series of new duties immediately commences ; and she must now 
 yield implicit obedience to the directions of her medical attend- 
 ant; she must have no opinions of her own, as regards her phy- 
 sical and medical treatment : submission is her duty, that she 
 may be able to discharge, in the best possible manner, the im- 
 portant task of watching over, and rearing her offspring. To 
 secure this power, the observance of the following rules, during 
 her month of confinement, will be found important. 
 
 CHAPTER VII. 
 
 CONDUCT DURING THE MONTH. 
 
 100. As the future health and welfare of the child, after birth, 
 mainly depend upon the healthfulness of the mother, and her 
 capacity to supply it with sufficient and proper nourishment, it 
 will follow, that this important office demands the utmost care, 
 that she may be enabled *to perform this delightful duty, with 
 comfort to herself, and advantage to her child — therefore, she 
 must, 
 
 101. 1st, Avoid causes, that may tend to produce or to aug- 
 ment fever ; as too early sitting up ; unnecessary exposure ; in- 
 dulging in too stimulating a diet, and drinks ; too hot a room ; 
 too nearly closed curtains; the exclusion of fresh air; and see- 
 ing too much company. 
 
 102. 2dly, She must aid, by her own good sense, the endea- 
 vours of her physician to prevent the accession of fever; by not 
 permitting the nurse, as is too often done, to run counter to his 
 directions; she must, therefore, carefully examine her articles 
 of diet, that no improper or forbidden substance enter into its 
 composition, as wine or liquor of any kind, animal food, or broths, 
 until after the complete secretion of milk has taken place, and 
 all risk of "milk fever," as it is called, be at an end; that is, not 
 until after the termination of the fifth day. 
 
48 OBSERVATIONS. 
 
 103. 3dly, With a view to give the best possible chance for 
 the breasts to perform their functions properly, and to prevent, 
 as much as may be, the occurrence of that bane to nursing, sore 
 nipples, she should have the child applied to them as soon as 
 she is sufficiently recovered from her fatigue to permit it ; and 
 this must be repeated every four or five hours, should nothing 
 occur to render it improper. 
 
 104. 4lhly, She must not delegate to any being the sacred and 
 delightful task of suckling her child, unless there be the most decided 
 and insurmountable impropriety in continuing it at her own breast, 
 
 105. 5thly, She should most scrupulously attend to the dress* 
 ing and undressing of her infant, if she cannot perform these of- 
 fices herself: and, also, pay the strictest attention to its clean- 
 liness ; not suffering it to remain either wet or soiled, under the 
 false pretext of making it hardy. 
 
 106. 6thly, The mother should not permit her child to be fed, 
 while she herself can supply it with sufficient nourishment : to 
 ensure this of proper quality, and in proper quantity, she should 
 eat nothing, which her experience has proved to be injurious; 
 and she should take as much exercise in the open, dry air, (as 
 soon as her health is sufficiently confirmed to permit it,) as will 
 contribute to the restoration of healthy action in her whole sys- 
 tem. 
 
 107. The rules we have just laid down for the woman's ob- 
 servance during her labour and her getting up, as it is familiar- 
 ly called, may require a few remarks to make them entirely in- 
 telligible, or to ensure conformity. 
 
 CHAPTER VIII 
 
 OBSERVATIONS ENFORCING THE FOREGOING RULES. 
 
 108. To the first (91) we may observe, that, in the present 
 improved state of midwifery, the risk of labour, when properly 
 
OBSERVATIONS. 49 
 
 conducted, is very much diminished. This improvement has 
 arisen from that change of manners, which placed the care of the 
 female, almost universally, in the hands of the male practitioner; 
 and to the latter cultivating this branch, upon correct and well 
 founded principles ; principles derived from the laws of nature, 
 and from correct observation. 
 
 109. The officiousness of ignorant practitioners, (as well male 
 as female.) of this branch of medical science, arising either from 
 a desire to be useful, or their supposing they can be so during 
 the progress of a natural labour, becomes a fruitful source of im- 
 mediate as well as remote evil. How many females may truly 
 date the origin of many long-continued diseases from the impro- 
 per interference and misconduct of the midwife or phvsician, in 
 their first confinement. 
 
 110. It is proper we should say a few words in defence of our 
 second direction, (92) as general opinion is against it ; but we can 
 safely say we have both reason and experience in its favour. 
 Towards the latter period of gestation, there is, we believe, in 
 almost all women, an inclination to repose; or it is rather, perhaps, 
 an aversion from exercise; this arises, in most instances, from the 
 inconveniences which are experienced from locomotion, owing 
 to the increased weight of the womb and its contents ; and the 
 constant exertion, necessary to preserve the centre of gravity* 
 Hence, we find women who may have borne several children, 
 experience oftentimes much difficulty in preserving their cen- 
 tre, owing to the advanced position of the uterus; especially after 
 the seventh month. Hence the disposition to a recumbent pos- 
 ture, as they find themselves more comfortable in it; and hence, 
 the impropriety of interfering with this instinct. Besides, a long 
 experience is in favour of our caution; we have a hundred 
 times seen pains of labour prematurely excited, by over-exercise, 
 near the end of gestation : we, therefore, uniformly protest, when 
 consulted on this subject, against long walks, &c, by way, as is 
 declared, of procuring a favourable delivery. 
 
 111. We are not, however, to be considered as unfriendly to 
 all exercise at this time; on the contrary, we frequently recom- 
 mend a moderate share of it — but we earnestly caution against 
 fatigue; and, consequently, forbid exercise, to an extent that will 
 produce it." And, if the analogv to which we have already ap- 
 pealed can furnish an argument in favour of our position, we may 
 
 7 
 
50 OBSERVATIONS. 
 
 certainly be taught a useful lesson, upon this subject, from the 
 practice of the brute creation. 
 
 112. The consolation afforded in our third rule, (93) is found- 
 ed upon extensive calculations, made from the reports of cases 
 from different parts of Europe, and of this country; as well as 
 upon those of many public institutions, in which the best possi- 
 ble chance offered itself for accuracy; and all of these tend to 
 show how few women now die in child-bed, except occasionally, 
 when some epidemic influence prevails to give child-bed fever. 
 But let it be remembered, that this exception is almost exclu- 
 sively confined to Europe, as we seldom or never witness such 
 an atmospheric agency in thi& country. • 
 
 113. The cautions, suggested in our fourth, (94) are the re- 
 sult of long and repeated experience ; for no truth connected 
 with the practice of midwifery is better established than the one 
 that declares, as a general rule, that the preparative stages of 
 labour, properly so called, should never be interfered with, by 
 any attempt to hasten, or retard their natural march. When this 
 has been attempted, the effects have ever been mischievous: 
 therefore, the whole discipline to which a young creature is sub- 
 jected by misguided gossips, or ignorant practitioners, especially 
 with her first child, cannot be too severely reprehended. But 
 we must not be understood to include in our censure, the proper 
 and well-timed administration of suitable remedies, to relieve 
 premature or inefficient pain ; which frequently attacks the fe- 
 male ; especially if her domestic duties require much or constant 
 exertion. 
 
 114. But, at the same time, let it be remembered, that, in ad- 
 ministering to real exigencies, much caution and judgment are 
 required ; and the cases where such necessity exists should be 
 confided to the care of an experienced practitioner. The indis- 
 criminate use of laudanum, the lancet, and stimulating teas and 
 drinks, cannot be too severely condemned, or too much feared. 
 
 115. Our fifth rule (95) is one of great importance, yet po- 
 pular feeling is decidedly in favour of its violation. It is wrongly 
 imagined, that great muscular strength is essential to the due 
 performance of labour, and that this can only be supported, by 
 the free use of nourishing and stimulating articles of diet; hence 
 the common practice of urging patients to eat and drink "to 
 keep up their strength;" and hence, the too frequent production 
 
OBSERVATIONS. 51 
 
 of fever. But let us place the result of experience in opposition 
 to it; — this declares, that relaxation is the most favourable con- 
 dition of the system for safe and speedy delivery. 
 
 116. The sixth admonition (96) is intended to prevent de- 
 spondency in consequence of protracted labour, especially with 
 a first child. It should be constantly borne in mind, that the 
 progress of labour is almost always slower with a first, than with 
 subsequent children : the cause of this peculiarity we are not ex- 
 actly prepared to state; the fact is notorious, however, and should 
 be declared to be so to the impatient sufferer ; especially when 
 it can also be confidently declared, that there is no more danger, 
 all things being equal, and under proper management, than with 
 any subsequent ordinary labours. This may tend to inspire a 
 proper confidence in the powers of nature, and in the skill of 
 the attendant*; points of much consequence, at this period of suf- 
 fering. Thus, needless anxiety and injurious impatience may be 
 prevented. Rules 7th, 8th, and 9th, sufficiently explain them- 
 selves. 
 
 117. The first rule (101) is intended to prevent that artificial 
 condition of the system, termed " milk fever:" we say, "artificial 
 condition of the system;" for such, in our estimation, it almost 
 always is. It is found constantly to exist, where the patient has 
 indulged in the early use of either distilled or fermented liquors, 
 animal food, broths, too great quantities of spices, or where any 
 of the other causes enumerated in the proscription are in opera- 
 tion. We could wish, that the directions contained in the rule, 
 (101) may not be carelessly passed over; as " milk fever " very 
 often leads to the necessity of pretty active medical discipline, 
 which must necessarily retard recovery, by producing weakness, 
 or what is oftentimes very much worse, the formation of " milk 
 abscess,'' — a disease of long and painful continuance, and some- 
 times the cause of the entire destruction of the future usefulness 
 of the breast itself. The child must now be robbed of its natu- 
 ral support, languish for want of proper nourishment, or be com- 
 mitted to the care of perhaps a careless or profligate nurse, who 
 may entail upon it never-ending disease or debility. 
 
 118. The second rule, (102) is an appeal to the good sense of 
 the patient, that the directions of her physician may not be dis- 
 regarded, or she become the sufferer by her own supineness. A 
 lying-in woman is looked upon, by the ignorant nurse, as in a 
 
;>2 OBSERVATIONS. 
 
 stale of great debility ; with a view to overcome this creature of 
 her imagination, she employs all her powers of cookery, for a 
 system already assailed, perhaps, by fever, or very certainly dis- 
 posed to it ; — fever is kindled, and sometimes, before it can be 
 quenched, the patient entirely succumbs, or escapes with a pain- 
 ful and protracted convalescence. Does it not then become the 
 duty, as well as the interest, of the patient, to co-operate with 
 her physician in the proper application of his remedies, and in 
 the observance of his directions ? It should be constantly borne 
 in mind, that no patient runs counter to the directions of her 
 physician, but at the risk of her health, perhaps of her life ; — 
 therefore, the common boast of ignorant and unprincipled nurses, 
 that they have " cheated the doctor," betrays at once their dis- 
 honesty and total unfitness for the duties they are hired to per- 
 form. If every woman would decidedly and firmly oppose the 
 impudent and dangerous practices of her nurse, when they run 
 counter to medical counsel, we have every reason to believe it 
 would not only abridge suffering, but also diminish the risk of 
 parturition. 
 
 119. Let it not be hastily assumed, that there is more safety 
 in following the directions of a nurse, than those of the physi- 
 cian, because she may have had some experience: for it must be 
 quickly perceived, that the calculation is much in favour of the 
 latter; for the nurse can attend but twelve patients per annum, 
 while the physician may visit several hundreds, in the same pe- 
 riod; besides, his knowledge of the laws of the human system, 
 gives him a very decided superiority. 
 
 120. Oar third direction (103) contains most important ad- 
 vice, and should be scrupulously complied with, if the woman 
 wish to avoid inquisitorial tortures, or be enabled to render jus- 
 tice to her child. A neglect of the caution suggested in the 
 article we are now commenting on, will almost certainly be fol- 
 lowed by sore or tender nipples. When this happens, a series 
 of evils constantly ensues. 1st. The mother suffers extreme 
 pain, whenever she attempts the duty of suckling; this necessa- 
 rily produces a great reluctance to apply the. child to the breast : 
 the period of its application is postponed from hour to hour, 
 until the painful distention of her breasts forces her to com- 
 pliance. But in consequence of the accumulation of milk in 
 the milk-vessels, they become over-distended, painful, or even 
 
OF THE TREATMENT OF THE NIPPLES. 53 
 
 inflamed ; so that, when the child is applied to the nipple, its 
 attempt to empty the breast is attended with such severe pain, 
 that the infant is almost instantly torn from it, leaving the part 
 denuded of its skin, and, perhaps, covered with blood. 
 
 121. Secondly, In consequence of the extreme reluctance the 
 mother feels to nursing her child under such circumstances, the 
 breasts are imperfectly emptied, and the milk becomes, as it 
 were, stagnant ; or, at least, it undergoes such changes, as render 
 it improper food for the child, and it also becomes impacted in 
 the lactiferous vessels. Accumulations are formed, inflammation 
 is excited, and milk abscess follows. 
 
 122. Thirdly, From the condition in which the breasts are 
 placed by the unexhausted milk, the child is not only made to 
 receive it of bad quality, but also, in an insufficient quantity; it, 
 therefore, throws it up, almost as soon as swallowed ; it is at- 
 tacked with disordered bowels and colic, and soon becomes most 
 miserably emaciated, when, perhaps, nothing but a fresh breast of 
 milk can save it from an untimely grave. The evils we have 
 here enumerated, are of frequent occurrence; and so certain are 
 they to foljow this condition of the nipples, that we declare we 
 have rarely seen a well nourished child, under such circum- 
 stances. 
 
 123. It follows then, that, as a sound condition of the nipples 
 is of the first consequence to the mother and the child, and as it 
 materially influences this future health of the latter, the conside- 
 ration of the best mode of preserving them, properly belongs to 
 our immediate subject 
 
 CHAPTER IX. 
 
 OF THE TREATMENT OF THE NIPPLES. 
 
 124. In treating this subject, we shall first briefly inquire into 
 the causes of sore nipples; and, secondly, point out the best 
 mode, with which we are acquainted, for their prevention, and 
 cure. 
 
54 Or THE TREATMENT OF THE NIPPLES.' 
 
 125. The removal of the skin which covers the nipple, by 
 the application of the child's mouth in the act of sucking, is al- 
 most always owing to the milk vessels-being over-distended, and 
 to an incipient inflammation besieging them in their course, and 
 especially their extremities, which open on the extreme end of 
 this organ; or sometimes to some of these little openings being 
 nearly or entirely obliterated by compression, or previous injury; 
 thus requiring considerable, and repeated force, to extract the 
 milk from them. The friction, which the nipples suffer, from 
 the attempt to draw off the milk, soon renders these parts ten- 
 der ; and, in a short time more, the skin is entirely removed. 
 From that moment, the woman bids adieu to all comfort, in suck- 
 ling ; for the child's frequent demands for nourishment, prevent 
 their healing. 
 
 126. Now, it would seem from the premises just laid down, 
 if we can prevent the over-distention, and inflammation of the 
 milk-vessels, and remove the obstructions from their external 
 extremities, we should destroy the necessity of that degree of 
 force, which we have just declared to be the efficient cause of 
 sore nipples; and, consequently, protect the woman against 
 them. To do this, we must most rigorously enforce the rules 
 we have laid down for the conduct of the woman immediately 
 after delivery, and persevere in them until the necessity shall 
 cease. 
 
 127. Besides this, the patient should begin to prepare these 
 parts previously to labour, by the application of a young, but 
 sufficiently strong puppy to the breast ;* this should be imme- 
 diately after the seventh month of pregnancy. By this plan 
 the nipples become familiar to the drawing of the breasts ; the 
 skin of them becomes hardened and confirmed ; the milk is more 
 easily and regularly formed ; and a destructive accumulation, 
 and inflammation, is prevented. 
 
 128. A variety of washes have been recommended for the 
 purpose of hardening the nipples; but, so far as we can learn, or 
 have observed, they have rarely succeeded ; nor can such washes 
 
 * We would not wish to be understood as considering the mouth of a pup bet- 
 ter than that of a nurse, or one who is accustomed to this operation; — on the con- 
 trary, when practicable, we would prefer the latter, as she can always regulate 
 the force necessary for this purpose. We merely recommend the pup, because 
 it is more easily procured. 
 
OF THE TREATMENT OF THE NIPPLES. 55 
 
 succeed often from their very mode of action — for it is not so 
 much an unusual tenderness of skin that gives rise to this com- 
 plaint, as the degree of force which becomes necessary to extract 
 the milk when these parts are over-distended, or inflamed. The 
 true theory, then, of prevention is, so to manage the breasts, that 
 neither over-distention, nor inflammation shall take place. ,We 
 have above suggested, the proper mode of doing this ; namely, 
 before delivery, by the regular application of the puppy; and, 
 after delivery, by the early application of the child to the breast, 
 and a strict antiphlogistic regimen. 
 
 129. Professor Osiander lays great stress upon the daily use 
 of lukewarm w T ater and fine soap; the nipples, he says, should 
 be washed with them every day, for some time before delivery; 
 by. which means the hardened scarf skin, after a short time, can 
 readily be removed by the finger, a blunt knife, or the edge of 
 a card. When this is removed, he recommends hardening the 
 tender nipple by certain stimulating applications ; but of which 
 we do not approve — the best plan, we believe, after washing, is 
 to expose the nipples to the air for a few minutes at a time, and 
 several times every day. 
 
 Dr. Strahl, in Rust's Magazine, recommends the following lo- 
 tion in very positive terms, by calling it a " specific." 
 B. Pulv. Gallse Alep. 3yj. 
 Vin. Alb. §vj, 
 
 digest with gentle heat for twent}^-four hours ; strain, and apply 
 compresses wet with it, three or four times a day, beginning as 
 early as the sixth month of gestation, and continue until the full 
 time. ' 
 
 130. It, perhaps, may be useful to suggest, that these impor- 
 tant parts are very frequently injured, by compressing them too 
 tightly against the breasts, with corsets, &c. This should be 
 guarded against with much care, by every female, whether she 
 be married, or single; and for this purpose they should be pro- 
 tected, especially in the pregnant woman, by an opening in the 
 jacket, corsets or stays, so as to leave them at perfect liberty. 
 
 131. Some women are so unfortunately organized, as to want 
 the nipple altogether, or to have it very short, or sunken in — 
 such may have the inconveniences, necessarily attached to this 
 mal-formation remedied or improved, by the early use of the 
 
56 OF THE MOTHER SUCKLING HER CHILD. 
 
 puppy, or the daily drawing them out with a large tobacco^ 
 pipe.* 
 
 132. Our fourth rule (104) contains one of the most impor- 
 tant injunctions we can give, or that the woman can receive; it 
 forbids her to delegate to another, the duty of suckling her child 
 — a duty rendered sacred both by nature and by reason — an em- 
 ployment, that awoke the poetic powers of a Tansillo, and 
 aroused the eloquence of a Rosseau. 
 
 CHAPTER X. 
 
 OF THE MOTHER SUCKLING HER CHILD. 
 
 133. We shall consider this subject under several of its rela- 
 tions: — 1st, that of duty; 2dly, of pleasure; 3dly, as it may affect 
 the mother's health ; 4thly, as regards the health of the child ,' 
 5thly, the consequences to both, when neglected; 6thly, the al- 
 ternatives for this neglect, and their effects. 
 
 Sect. I. — As a Duty. 
 
 134. God has declared almost in every part of his living crea- 
 tion, that the female, for a certain time, is the natural protector 
 of her offspring ; to the human female he has been particularly 
 
 * Mrs. was confined with a fine healthy boy : — the secretion of milk was 
 
 most plenty and favourable; but the child could not be made to take hold of the 
 breast, as the nipples were inverted. The breasts became painful from extreme 
 distention; as even the nurse, who was well skilled in drawing-breasts, could not, 
 without much difficulty, extract sufficient to take off distention. Much mischief 
 was now threatening. Milk abscesses were to be feared; the child was obliged to 
 have a wet nurse, and the pain the mother suffered from the breasts was only 
 relieved by bleeding, purging, extremely spare diet, and the application of hot 
 vinegar; every thing, however, terminated favourably, by a rigid adherence to 
 this plan. Upon the next occasion, a pup was procured, and the breasts were 
 drawn several times every day; the nipples were now made to appear, as the 
 breasts were not distended; this plan was pursued until after her delivery, and r 
 by the time milk was formed, the child had very good nipples to take hold of. 
 
OF THE MOTHER SUCKLING HER CHILD. 57 
 
 emphatic, implanting in her affections, which are rarely subdued ; 
 and by giving her an organization most wonderfully fitted for the 
 exercise of her best and most enviable feelings. He has given 
 her double means to furnish nourishment for her helpless young, 
 lest accident should circumvent his kindest purpose; and he has 
 so arranged their powers as to yield the wonted supply, as soon 
 as that supply may be necessary. 
 
 135. Every woman feels, but all unfortunately do not obey 
 these powerful appeals — to the latter, and to the latter only, is 
 it thought necessary to address arguments for the discharge of one 
 of the most sacred of duties; and to make her, if possible, alive 
 to her own interests and her own happiness. 
 
 136. We are truly happy to find, and equally so in this oppor- 
 tunity to declare, that the number of women who may stifle this 
 strong maternal yearning, is comparatively small, and form only 
 exceptions to the noble rule — and that it may ever continue to 
 be so, we most devoutly pray. That such exceptions have always 
 existed, our earliest records would seem to declare ; and, that the 
 example has never had but very limited influence, we are proud 
 to admit — for, to the honour of human nature, such mothers have 
 ever been the subject of the satirist's lash, and the object of the 
 moralist's declamation. 
 
 137. By some, this neglect has been looked upon as absolutelv 
 criminal : and by Tansillo, no distinction is made between the 
 woman who voluntarily procures abortion, and the one who 
 abandons her child to the care of others, and leaves it to perish; 
 for he asks — 
 
 " Does horror shake us when the pregnant dame, 
 To spare her beauties, or to hide her shame, 
 Destroys, with impious rage, and arts accurst, 
 Her growing offspring, ere to life it burst — 
 And can we bear, on every slight pretence, 
 The kindred guilt that marks this dread offence f 
 
 She, who to her babe her breast denies, 
 The sentient mind, the living man destroys." 
 
 The Nurse, translated by JRoscoe, p. 11. 
 
 138. In such light is the mother's voluntary abandonment of 
 her child viewed by a stern morality — we, however, do not regu- 
 late our opinion by so rigid a standard ; for, we hold it right in 
 this, as in every instance of imputed turpitude, to fix the grade 
 
 8 
 
58 OF THE MOTHER SUCKLING HER CHiLi*. 
 
 of enormity by the quo animo ; and, if this be made the test, as 
 it certainly should be, it will be found much less flagrant than it 
 would appear at first sight: for, we know that but few mothers 
 could be found, who would voluntarily consign their offspring to 
 inevitable death ; and we believe, when this cruel and unnatural 
 repudiation takes place, it is generally owing to a temporary, but 
 morbid suspension of the social and moral perceptions, rather than 
 to a destruction of them ; and, were proper means judiciously 
 applied, they might be recalled, and the woman restored to a 
 healthy and natural state of feeling. 
 
 139. It should be made known to her who may feel a tempta- 
 tion to put away her child, from mere selfish gratification, that 
 it has also been a subject of question, " whether the child which 
 has been voluntarily abandoned by the mother to the care of 
 others, should owe a tie, of either consanguinity, or of gratitude 
 to her." This doubt must be resolved by the mother herself — 
 we shall not undertake to decide it, lest our feelings should be- 
 tray a stronger bias, than should justly attach to the subject, 
 from the hasty consideration we have given it. 
 
 140. It would not, however, be right to throw all the blame 
 upon the mother who does not suckle her child ; the husband is 
 sometimes so fashionably selfish ; so unnaturally studious of his 
 own ease, or comfort ; and so ridiculously vain of his wife's ap- 
 pearance, as to force a tender and affectionate mother from her 
 duty ; and this, sometimes, even to the sacrifice of her health, as 
 well as that of his child. In this country, this character is much 
 more rare than in Europe; and we sincerely hope, they may 
 never increase, either by the contaminating influence of example, 
 or by the destruction of social virtue. 
 
 141. In a political point of view, this subject may well merit 
 consideration; for the pride of birth and of blood may, justly, 
 take the alarm, if the theory of Tansillo have a foundation : for 
 he asks — 
 
 "Why, 'midst the fellow tenants of the earth, 
 This high respect to ancestry and birth? 
 Avails it aught from whom the embryo sprung, 
 What noble blood sustained the imprison'd young, 
 If, when the day-beam first salutes his eyes, 
 His earliest wants a stranger breast supplies? 
 From different veins, a different nurture brings, 
 Pollutes with streams impure the vital springs, 
 
OF THE MOTHER SUCKLING HER CHILD. 59 
 
 Till every principle of nobler birth, 
 Unblemish'd honour and ingenuous worth, 
 Absorb'dand lost, he falsifies his kind, 
 A grovelling- being with a grovelling mind." 
 
 The Nurse, p. 27. 
 
 Sect. II. — As a Pleasure. 
 
 142. If we can believe the fond mother upon this point, there 
 is no earthly pleasure equal to that of suckling her child — and 
 if any reliance can be placed upon external signs, she is every 
 way worthy of belief. This pleasure does not seem to be the 
 mere exercise of social feeling while the mother is witnessing the 
 delight of the little hungry urchin, as it seizes upon the breast 
 — nor from the rapturous expression of its speaking eye, nor the 
 Writhing of its little body from excess of joy — but from a positive 
 pleasure derived from the act itself; for most truly it may be 
 said, when 
 
 " The starting beverage meets its thirsty lip, 
 'Tis joy to yield it, as *tis joy to sip." 
 
 The Nurse, p. 15. 
 
 143. Yet there are mothers who voluntarily forego this plea- 
 sure, by committing their helpless offspring to mercenary nurses; 
 or who fail not to mar it, by degrading this delightful act to a 
 task by reducing the periods for its performance to rule; and 
 even this rule, regulated by selfishness, rather than by the de- 
 mands of their beseeching infant — but in yielding thus to sinister 
 feelings, may it not be justly considered a moot point, whether 
 such a woman should be most pitied or despised 1 for she may 
 well be asked, if, by this neglect, 
 
 " She can hope to prove 
 
 More bliss from selfish joys, than social love? 
 
 In part, even a father, upon such occasions, knows how to 
 feel a mother's joy, or an infant's bliss ; nor would he yield 
 them, for any price. 
 
 Sect. III.— As it may affect the Mother's Health. 
 
 144. Nature here pleads her own cause, by creating, and 
 even perpetuating disease in the mother, who may refuse this jus- 
 
60 OF THE MOTHER SUCKLING HER CHILI?. 
 
 tice to her child — she becomes liable to milk abscess in its worst 
 form; to translations to various parts of the body; to congestions 
 in the milk glands, which may become scirrhi, or even cancers. 
 We have known, in several instances, long-protracted headachs 
 to follow this unnatural abandonment of the child, which no- 
 thing but time seemed capable of relieving. One case, in par- 
 ticular, may be worthy of relation, as it is every way in point : 
 
 Mrs. , the mother of several children, was severely afflicted 
 
 with headach, sore eyes, and a long train of nervous symptoms, 
 which rendered her life miserable, and for which almost every 
 remedy had been tried in vain. 
 
 , 145. We attended her for these complaints, at the desire of a 
 friend; but as she was pretty far advanced in her fifth pregnan- 
 cy, we could neither hope nor promise to do much for her relief 
 at that time; we, however, commenced a very particular in- 
 quiry into the origin and progress of her disease. From this we 
 learned that these unpleasant symptoms attacked her soon af£er 
 her first confinement ; and they seemed to gain ground, after 
 each of these events, until they became almost unsupportable. 
 
 146. Immediately after each confinement, and for a short pe- 
 riod in the month, she would experience a slight relief; but by 
 the time her month was up, it would return with renewed force, 
 and would leave her but at rare intervals, even for an hour. 
 We next inquired into her habit as regarded nursing her chil- 
 dren ; and understood that she had never suckled one of them ; 
 having lost her first a few days after its birth, she dried up her 
 milk, and was soon after attacked with the complaints just men- 
 tioned. But so far from either herself or her friends attaching 
 any blame to the sudden repulsion of the milk, that she was for- 
 bidden by her husband, her friends, and her physician, from 
 ever attempting this office, as she had become so extremely de- 
 bilitated, in their apprehension, as to render even the attempt 
 dangerous — accordingly, a wet nurse was always procured be- 
 forehand ; and the mother's milk, as before, was prevented 
 from taking its course. 
 
 147. From this account, as well as from a variety of other de- 
 tails not necessary to mention, we were at once instructed in the 
 nature of her disease— for it was nothing more than a plethora 
 arising from repelled milk ; for the cure of which, we proposed 
 she should nurse the child she was then pregnant with, and to 
 
OF THE MOTHER SUCKLING HER CHILD. 61* 
 
 follow such farther directions as the necessities of the moment 
 might suggest — this was agreed upon. In due time, she was 
 delivered of a small, but apparently healthy child — the child 
 was early put to the breast, in conformity with our practice ; 
 strict attention was paid to the mother, as regarded regimen, 
 &c, during the month. Milk was plentifully secreted in proper 
 time ; the child throve ; and the lady never had a return of 
 headach ; her eyes became strong and perfectly sound, and the 
 whole train of nervous symptoms vanished, to return no more. 
 These are not the only advantages of this plan — we are of 
 opinion that the risk of child-bed fever is much diminished by 
 the mother suckling her child — for the consent or sympathy be- 
 tween the uterus and breasts is well known; and had not escaped 
 the observation of the sagacious Hippocrates, two thousand years 
 ago. 
 
 148. This case is replete with instruction to the mother, who 
 may voluntarily abandon her infant, by showing that a severe 
 and protracted disease may follow what she might look upon as 
 a safe expedient; it is full of practical importance to the phy- 
 scian, who may be tempted to disregard the consequences of 
 " repelled milk.'* But though confessedly important, it is neither 
 new, nor rare — for unnatural mothers, "over-tender, and fashion- 
 able husbands," and inexperienced physicians, have ever existed. 
 Tansillo, whom we have already so often quoted, was one of the 
 "over-tender, and fashionable husbands;*" and laments in a 
 strain of beautiful pathos, his error on this subject, in the follow- 
 ing words : after having just before described the evils which 
 this practice might give rise to, he says — 
 
 " Nor think your poet feigns. Alas! too well 
 By dear experience I the truth can tell; 
 In dread suspense, a year's long- circuit kept, 
 And seven sad months I trembled and I wept, 
 Whilst a lov'd consort pressed the couch of wo, 
 And death oft aim'd the oft averted blow, 
 Nor hers the fault — misled by fashion's song", 
 'Twas I deprived the mother of her young; 
 Mine was the blame; and I, too, shared the smart, 
 Drain'd was my purse, and anguish rung my heart." 
 
 149. It may be asked is every woman capable of nursing her 
 child? To this we must answer, No : and when we declare it to 
 
62 OP THE MOTHER SUCKLING HER CHILD. 
 
 be the duty of every mother to do so, it is to be understood only 
 as referring to every mother who is capable of this important 
 office. We are aware there are causes which will render this 
 attempt neither obligatory, nor even proper; but such cases 
 should be carefully distinguished; and should only be considered 
 such, when they have the sanction of an experienced physician 
 — neither the want of inclination to fulfil one of the most im- 
 portant duties of female life; nor the specious pretext of feeble, 
 or ill health, should ever be admitted as sufficient reasons for 
 such dereliction. 
 
 150. To the intelligent practitioner, these pretexts are of easy 
 detection ; and to render it within the capacity of any one, he 
 need but recollect the consequences of the judgment of Solomon, 
 upon (we had like to have said,) a similar occasion. The pro- 
 position to separate the child from the feeling mother is heard, 
 as if it were her death knell; but by the selfish and unfeeling 
 one, is received with decided approbation, if not with joy. Of 
 the causes which would render it improper for the woman to 
 suckle her child, we shall have occasion to speak under the 
 head of "food." 
 
 Sect. IV. — As it may affect the Child. 
 
 151. As we hold it to be an indispensable duty on the part of 
 the mother to suckle her child, so nothing but the most satisfac- 
 tory evidence of incapacity, or of bad milk, should be admitted, 
 as a reason for its neglect — but as such satisfactory evidence 
 must necessarily sometimes exist, it follows, that the child must 
 become an alien to its mother's bosom. In such a case, it is the 
 exception and not the rule that is acted upon. 
 
 152. The arrangement made for the nourishment of the child 
 by the secretion of milk, declares, as we have already said, a 
 mother's duties towards it ; it also forces upon us the truth, that 
 none other can be so entirely proper as that which she is des- 
 tined to furnish. If this be true, as it unquestionably is, it fol- 
 lows as a consequence, that the child must incur a greater or 
 less risk whenever it is deprived of it, either by choice or by 
 necessity ; it is, therefore, proper that we consider the nature 
 of that risk. 
 
 153. The injuries which a child may receive when con- 
 demned to the care of a hireling, may be of two kinds; namely, 
 I. Physical, and II. Moral 
 
OF PHYSICAL INJURIES, 63 
 
 CHAPTER XL 
 I. OF THE PHYSICAL INJURIES. 
 
 These may be inflicted upon the child by a deficiency of 
 milk; by its bad quality; by a just and proper care not being 
 paid to its many necessities; by the selfishness of the nurse ; 
 and by the propagation of an actual, or an occult disease. 
 
 Sect. I. — By a Deficiency of Milk. 
 
 154. As there cannot be any absolute security against impo- 
 sition from that class of females who hire themselves for wet 
 nurses, there must be a constant liability to be deceived. For, 
 as a matter of course, they will answer questions in such a man- 
 ner as will give the best chance to be engaged; they will there- 
 fore declare they have the greatest abundance of milk, and will 
 offer, perhaps, in proof of it, a fully distended breast — you re- 
 ceive them under such appearances; and your child for the first, 
 and perhaps the last time, receives a sufficient supply. 
 
 155. For, upon subsequent applications of the child to the 
 breast, it is obliged to put up with meager fare — the woman, 
 aware of the deception she has practised will be discovered with- 
 out the exercise of both cunning and address, has immediate re- 
 course to clandestine feeding ; and that, perhaps, of the most va- 
 ried, and improper kind. Under such management, the child 
 soon becomes pained and fretful, from a deficient and improper 
 diet; but the fears of the mother are for awhile appeased by the 
 nurse declaring it to be the t{ colic" attendant upon a change 
 of milk. Things proceed pretty much after this feshion for some 
 time longer ; and though the child cries less, and sleeps a great 
 deal, it does not thrive! — but, on the contrary, there is a great 
 falling off, and, perhaps, a severe diarrhoea is added — the mother 
 now takes the alarm; and her physician is consulted. From the 
 history given, he suspects the true cause of the child's dimi- 
 nished health — an inquiry is instituted, and it eventuates in the 
 discovery, that the nurse has not sufficient milk, and that the 
 child has been quieted and apparently satisfied, by the regular 
 
G4 Or PHYSICAL INJURIES. 
 
 exhibition of laudanum!! This is not " fancy's sketch " — it is 
 drawn from the life. 
 
 Sect. II. — From Milk of a Bad Quality. 
 
 156. The healthy quality of milk may be destroyed, or im- 
 paired sometimes without its quantity being very sensibly dimi- 
 nished ; and though the child may receive abundance, it may not 
 be sufficiently nourished. When this happens, we find the child 
 rejecting the milk soon after it is received ; or it passes with ra- 
 pidity and pain through the bowels. If the diapers be examined, 
 the evacuations will be found copious and watery: offensive in 
 smell ; of a light green colour, and mixed with a portion of un- 
 digested milk curd. These discharges may not be very frequent; 
 yet so large, as rapidly to weaken the child; a proof, that but a 
 small proportion of the milk received had been converted into 
 nourishment. 
 
 157. The child becomes uneasy, fretful, and very frequently 
 disturbed in its sleep ; it suddenly cries as if in violent pain, and 
 again falls into unrefreshing slumbers. It becomes pale ; its flesh 
 is flabby ; and after a short continuance in this state, emaciates 
 suddenly and becomes alarmingly ill from diseased bowels, or 
 disordered head. 
 
 158. There are many causes which may give rise to this bad 
 state of the milk — improper diet; a deranged state of the sto- 
 mach ; the too free use of ardent or acescent drinks ; bad orga- 
 nization of the breasts themselves ; too great age of the milk ; 
 the irregular returns of the catamenia, &c. &c. 
 
 Sect. III. — A want of due Care to the various Necessities of the 
 
 Child. 
 
 159. It truly requires all the affections of even a fond mother, 
 to administer duly to the numerous wants of a young child — we- 
 mean here only such wants, as are really essential to its health 
 and comfort, and not those of an artificial kind, which a fastidi- 
 ous and capricious taste may quickly create. The cares essen- 
 tial to the comfort of the child, consist in the proper and regu- 
 lar application of it to the breast, that it need not suffer from 
 hunger, or be injured by too long abstinence ; in a proper, and 
 
OF PHYSICAL INJURIES. 65 
 
 due attention to cleanliness; and in the establishment of regular 
 and useful habits, as regards exercise, exposure, sleep, and eva- 
 cuations. 
 
 160. It will readily be admitted, that the proper discharge of 
 these essential points requires more affection for the child, and a 
 higher sense of duty, than can generally be found united in a 
 wet nurse; and it also follows, if they are all, or even in part 
 neglected, that the child must suffer. 
 
 Sect. IV. — From the Selfishness of the Nurse. 
 
 161. Mothers who are fondly attached to their children, are 
 fully aware of the many privations they are obliged to submit 
 to, while they continue to be nurses; and they but too often feel 
 that it requires " all a mother's love," to perform the various 
 duties of one without complaining, or feeling " the task, severe." 
 It must not then be a matter of surprise, that the hireling be- 
 comes restiff, and negligent, under the discharge of her multi- 
 plied cares; and the child suffers in consequence. 
 
 162. This selfishness, however, may exist in different degrees ; 
 and the child will suffer, of course, in proportion to the neglect 
 it may experience. One of the most common causes of neglect, 
 is, where the duty to the child interferes with the engagements 
 of the nurse, and thus interrupts the consummation of antici- 
 pated pleasures. Should this happen several times in pretty 
 quick succession, she becomes soured, and will contrive that it 
 shall not happen soon again. 
 
 163. Nurses generally make a point to have a certain period 
 of the day at their command ; and should they find this hour re- 
 peatedly interfered with by the wakefulness of the child, they 
 will soon have recourse to such means as shall prevent its future 
 recurrence. We have known a number of cases where lauda- 
 num was administered for this purpose, with so much cunning, 
 as to elude detection for a long time, even after the suspicion 
 had been excited. In one of these instances, the wily nurse 
 boasted to the abused parent, of her good management, in esta- 
 blishing so much regularity in the child's sleeping. 
 
 164. When a nurse is determined to employ laudanum for si- 
 nister purposes, she may do it for a long time before she maybe 
 
 9 
 
66 OF PHYSICAL INJURIES. 
 
 detected, notwithstanding the vigilance of an anxious mother. 
 There are moments, when she must be alone with the child ; and 
 there are stratagems, by which her purpose is effected, of which 
 the parent never dreamed. One of the most remarkable of this 
 
 kind we have met with, we will relate. Mrs. requested us 
 
 to visit her infant of nine months old, which, without any appa- 
 rent indisposition, had slept unusually long, and unusually sound, 
 for two or three days. When we arrived, the child was still 
 asleep ; we sat by the side of its cradle for some time, in order 
 to observe any phenomena that might present themselves. The 
 character of the sleep was marked by that peculiarity which a 
 practised eve, and ear, immediately ascribes to opium; and we 
 accordingly declared it to be our opinion, that the child had 
 taken a quantity of this drug. 
 
 165. Both mother and nurse protested in the most positive 
 manner, that it had not taken a particle of that medicine in any 
 form whatever — we were equally positive it had ; and directed 
 our curative plan upon this belief. Upon our next visit, the 
 child was much relieved— it had vomited freely, and had kept a 
 considerable quantity of rich lemonade upon its stomach, which 
 seemed to control the influence of the (as we supposed) lau- 
 danum. 
 
 166. Before we left the house, we reiterated our suspicions to 
 the mother — she, as before, was very certain, it had taken no ; 
 laudanum; and urged in support of this belief, that the nurse 
 never had been left alone with the child for a single instant ; for 
 when she was about to leave it herself, she was sure to place a 
 young woman in the room, in whom she had the most entire 
 confidence; and this young woman had assured her, in the most 
 solemn manner, that she never saw her give the child any thing 
 whatever, with the exception of the breast. We, however, did 
 not give up our first opinion, and proposed to the mother, when 
 the nurse was asleep, to make an examination of her pockets; 
 in one of which we were sure a bottle of laudanum would be 
 found. At our visit the next morning, we were told by the mo- 
 ther, with tears in her eyes, that a vial of laudanum, as we had 
 suspected, was found in a little pocket within the other pocket, 
 and which was made for the express purpose of holding it. 
 Though the laudanum was found as just stated, the manner of 
 its exhibition was still a mystery, especially, as we were con- 
 
OF PHYSICAL INJURIES. 67 
 
 vinced, from what Mrs. herself said, as well as the declara- 
 tions of the yOung woman, that the nurse had never been left 
 alone, even for a moment, with the child. It was, however, 
 now certain in all our minds that it had been given by some 
 stratagem or other; and, with the hope of detecting the method, 
 we inquired of the young woman, whether she had ever seen 
 her make any applications to her nipples, for any purpose, or 
 tinder any pretext whatever? She said she had; she had seen 
 her apply the mouth of a vial containing the tincture of myrrh 
 to her nipples, every day, for the purpose as she, the nurse, had 
 said of hardening them. The mystery was now explained— it 
 was laudanum, and not the tincture of myrrh which had been 
 thus ingeniously applied; and by permitting it to dry from time 
 to time, a sufficient quantity of opium was accumulated upon the 
 nipple, to cause the deep sleep in which the child was found. 
 
 This nurse had been permitted to visit her own child, every 
 afternoon, when the nurse-child was not awake, to require her 
 attention; she, accordingly, procured a regular sleep at this time 
 of day by the aid of .laudanum, that she might get abroad with 
 certainty. 
 
 167. The selfishness of a nurse may show itself in other ways; 
 namely, by eating and drinking such articles as she knows will 
 disturb the stomach and bowels of the child, but has not sufficient 
 feeling to give up the gratification of her own appetite for its 
 benefit. The child becomes tormented by colic, or other affec- 
 tions, which are only relieved by repeated doses of laudanum, 
 Until a habit is created, which it is almost impossible to break — 
 the consequences of such conduct are well known to every body- 
 
 168. Again, the life of the child may be forfeited, in case of 
 its illness, by the too free indulgence of the nurse's appetite — in 
 many instances it is of vital importance that the quality of the 
 milk should be altered by a change of diet imposed upon the 
 nurse — but will the selfish woman conform rigidly to the instruc- 
 tions of the physician for this purpose? Tansillo decides that 
 •she will not: — 
 
 " Sick, pale, and languid, when your infant's moans* 
 Speak its soft sufferings in pathetic tones, 
 When nature asks a purer lymph subdued, 
 By needful physic, and a temperate food; 
 
68 OF PHYSICAL INJURIES. 
 
 Say, will the nurse her wonted banquet spare, 
 And for your infant stoop to humbler fare? 
 Or with her pamper'd appetite at strife, 
 One portion swallow to preserve its life? 
 Self her sole object — interest all her trade, 
 And more perverse the more you want her aid." 
 
 The Nurse, p. 51. 
 
 169. But, perhaps, nothing displays the selfishness of the nurse 
 in such strong relief, as the tyranny with which she attempts 
 to govern the whole house — every body, and every thing, is 
 laid under contribution, that her wayward pleasures may be 
 gratified — if she frown, is sullen, angry, or capricious, every 
 thing must be yielded, that her perturbed spirit may be ap- 
 peased ; and her demands increase in proportion, as. they may 
 have been gratified. 
 
 Sect. V. — By the Propagation of an active, or occult Disease. 
 
 170. We have had many opportunities of witnessing injuries, 
 arising from this cause, when it was too late to prevent them . 
 nor could they have been detected at the proper moment, what- 
 ever may have been the skill of the physician, or the vigilance 
 of the parent. Diseases of the skin, as the itch, perhaps tetter, 
 have been so frequently propagated, as to become familiar to 
 the observation of every body; and in two instances, we had the 
 immediate care of those who had received, from the nurse, the 
 most loathsome and horrible of all diseases : it was communicated 
 not only (o the children who were at the breast, but also to four 
 older ones. 
 
 171. These cases are not so rare as we might hope ; especial- 
 ly on the continent of Europe. They are more rare in Great 
 Britain, and still more rare in this country. Rosenstein, in his? 
 treatise on the diseases of children, relates, that in a respectable 
 family in Stockholm, the father, the mother, three children, the 
 maid-servant, and two clerks, were infected with the venereal 
 disease, by a nurse who was admitted into the family without 
 previous inquiry into her character. 
 
 172. How far this last disease may be communicated by mere- 
 ly drawing the milk of a woman who may have it in a secondary 
 form, we are not exactly prepared to say, from our own experi- 
 ence — there is much testimony in favour of such a transfer ; but 
 
OF MORAL INJURIES. 69 
 
 there is much reasoning against it : yet there is one concession 
 all will be willing to make — namely, that there is a risk in em- 
 ploying a nurse so circumstanced. 
 
 CHAPTER XIL 
 
 OF MORAL INJURIES. ' 
 
 173. The moral influence the nurse may have upon the child 
 every body is aware of; the parent may attribute to her almost 
 whatever the child. may become in after life. On this account, 
 the moral habits of the nurse are almost paramount to her capa- 
 city to afford the proper nourishment — the hero, and the pol- 
 troon ; the liar, and the man of truth; the timid, and the daring; 
 the superstitious and the rational ; the modest, and the pre- 
 suming; the amiable, and the froward; the humble, and the ar- 
 rogant ; the passive, and the active — all have received the first 
 impulse of character in the nursery. 
 
 174. Baldini, as quoted by Struve, relates the case of a little 
 girl, of seven years old, who had an irresistible desire to drink 
 brandy, which she had contracted by drawing the breasts of a 
 nurse who was an habitual tippler. If this be so, more faith 
 may be given to the story of Nero and his nurse than is corn- 
 monly bestowed upon it. 
 
 CHAPTER XIII. 
 OF DRESSING, &c, THE CHILD. 
 
 175. Our fifth direction (105) recommends that a mother 
 jhould pay attention to the washing, dressing, and undressing of 
 
70 OF DRESSING, &C, THE CHILD. 
 
 her child. This advice, at first sight, might appear to be im> 
 posing upon her a task of great labour ; but it is not so — and if 
 it were even much more so than it is really found to be, it should, 
 nevertheless, be considered as one belonging to her. She need 
 not do the mechanical part of this important operation; but she 
 should never withdraw her eye from her child while it is per- 
 forming. The operation of dressing properly consists, in the 
 washing and putting on the clothes of the child — and, first, 
 
 Sect. I. — Of Washing. 
 
 176. There must necessarily be a period at which the mother's 
 absolute presence cannot be expected at the washing of her 
 child ; but there is none at which she cannot make her wishes 
 known upon this point of discipline. But as young mothers are 
 rarely well instructed upon this point, we shall offer a few rules* 
 which she can either adopt in their full extent, or so modify, as 
 may best suit her particular case, or as future experience may 
 suggest. 
 
 177. The object of washing, is to remove from the surface of 
 the body all impurities it may have contracted, either visible or 
 invisible, by the aid of water and of soap. 
 
 178. A newly born babe has always attached to its surface an 
 impurity, which it brings with it from its mother's womb; this 
 substance most resembles an imperfect, soft fat ; it is very tena- 
 cious, and oftentimes is of very difficult removal. A question has 
 arisen whether this should be removed. A certain German pro- 
 fessor, some years ago, insisted it should be let alone, as it would* 
 in the course of a few days, become dry, and peel off spontane- 
 ously. This is strictly true ; but does this fact prove the pro- 
 priety of permitting it to remain on the surface of the body? 
 Certainly, it does not; and for the following reasons: — 
 
 179. 1st When this substance has not been cleansed from the 
 body, either from careless washing, or from the difficulty found 
 in its removal, it has always produced a very disagreeable smell; 
 
 180. 2d. When it has been suffered to remain from any cause, 
 it has hardened itself so much as to give pain from its mechani- 
 cal irritation. 
 
 181. 3d. When it has been suffered to dry, it has remained, in 
 some instances, so long, as to leave the surface under it, so se* 
 
OF DRESSSING, &.C., THE CHILD. 71 
 
 verely excoriated, as to require particular attention, for some 
 days. 
 
 182. For these reasons, we are persuaded it is highly proper 
 that this substance should be removed from the body of the child 
 as completely as possible at the first washing. It is, also, proper 
 to point out the best mode of doing this. Every part of the child 
 should be smeared with fine hog's lard, before water is applied. 
 This being done, the child should then be carefully washed with 
 lukewarm water, and fine soap. The nurse will be much aided in 
 this operation, if she employ a piece of fine flannel, or sponge, 
 instead of linen, or cotton rag ; as the former will detach the of- 
 fensive substance much more readily than the latter. 
 
 183. Great care should be taken to remove this substance from 
 every fold of the skin, and especially from the joints, groins, arm- 
 pits, &c, that excoriations may not follow from the omission. 
 
 184. We italicized the words, "lukewarm water and fine 
 soap," that we might give our opinions upon each of these means 
 — and, first, of lukewarm water. We have ever held it proper to 
 use the water a little warmed for new-born children, as the ap- 
 plication of cold water is, in our opinion, too severe. Let it be 
 recollected that the child has been suddenly removed from a 
 temperature of at least 98° of Fahrenheit's thermometer, to one 
 almost at all times lower; and very often very much lower; and 
 that this transition has a very powerful effect upon its nervous, 
 its muscular, and its sanguiferous systems. The first is known 
 by the suddenness and the violence of its cries; the second, by 
 the very powerful contractions and relaxations of its little limbs 
 and body ; and the third, by the rapidity of its circulation. 
 
 185. It must also be kept in mind, that warmth is a sine qua 
 non to a newly born child ; for the heat it brings with it into the 
 world, is nothing but the heat of communication ; or, in other 
 words, that which it derives from, its mother ; and would be very 
 quickly dissipated, if not carefully cherished by external means. 
 For, to acquire heat of its own, if we may so term it, requires a 
 free use of its lungs, and the complete establishment of its circu- 
 lation, for some time. Then, why should its little sum of warmth 
 be wasted in conformity to an hypothesis 1 for, it is nothing more, 
 when cold water is used, with a view " to make the child 
 strong." And we will now ask, for the sake of information, can 
 any one reason be given why a child should acquire strength by 
 
72 OF DRESSING, &C, THE CHILD. 
 
 the use of cold water? We shall have occasion to advert again 
 to this subject. 
 
 186. We have repeatedly seen it require the lapse of several 
 hours, before reaction could establish itself,"* during which time, 
 the pale and sunken cheeks, and the livid lips, declared the al- 
 most exhausted state of its excitability. We are persuaded we 
 have known death itself to follow the use of cold water, for the 
 first washing of the child. It is true, in these instances, the chil- 
 dren were born feeble, and required but little of improper ma- 
 nagement to destroy them ; but, at the same time, it should be 
 recollected, had their little powers been well husbanded, they 
 might have been restored to good and perfect health. 
 ~2 187. Rousseau condemns the application of warm water to 
 even the new-born child ; or, at least, he says, " Warming the 
 water may be as well dispensed with: as among many different 
 people the children are taken immediately after their birth and 
 bathed in the river or sea." This appears to us an act of ne- 
 cessity, rather than of choice; since few, we believe, do this, but 
 people in savage life, where, from their erratic habits, few oppor- 
 tunities are offered for this kind of ceremony. Indeed, a people 
 of this kind rarely have the conveniences for the purpose of 
 heating water ; therefore, a necessity must not be mistaken for a 
 wise speculation on future good health. But, if this were even 
 strictly true, what does it prove ? Is there any evidence that the 
 children thus treated are of better health than those managed in 
 the opposite mode 1 There is no such evidence ; for, were it 
 even proved that the health of a people who, from birth, used 
 cold water, was better than those washed with warm, we might 
 justly doubt whether this increase of health depended upon this 
 circumstance alone. 
 
 188. Indeed, Rousseau himself seemed to answer this question 
 in the negative, since he attached so much consequence to a 
 country life, to uniform employment in the open air, to a free, 
 and active exercise of the body in the various duties of the hun- 
 ter, the shepherd, and the farmer. 
 
 * I was informed, within a few days, by an experienced nurse, that, upon one 
 occasion, where it was insisted on by the father that the child should be washed 
 in cold water, that the little creature did not recover its warmth for twenty-four 
 hours, though every expedient was employed for this purpose — the washing 
 with cold water was not repeated, of course. 
 
OF DRESSING, &C, THE CHILD. 73 
 
 189. We have every reason to believe that catarrhal affec- 
 tions have been produced by the use of cold water, especially 
 in very young children, from which the poor little creatures 
 have escaped with much difficulty. Now, as serious evils may 
 arise from ablutions of cold water, and as we have never heard 
 it even suggested that immediate injury has followed the use of 
 warm, the line of conduct to* be pursued would seem to be very 
 easy to make choice of. 
 
 190. Some, with a view to improve the quality of the water, 
 add brandy or other liquors to it; or, if they do not mingle these 
 with the water, they very carefully wash the infant's head with 
 some one of them, for the purpose, they say, of strengthening it. 
 This practice, though not so extensively injurious as the one just 
 spoken of, is nevertheless decidedly improper. There cannot 
 be any possible necessity for thus violently stimulating the poor 
 babe — thus do they " banish simplicity from even dressing a new- 
 born child." 
 
 191. And, 2dly, of " fine soap ;" this direction should be careful- 
 ly obeyed : a neglect of it is sometimes attended by great injury 
 to the child. There is a brown, and highly stimulating soap in 
 common use, called " rosin soap," because this substance enters 
 very largely into its composition : this, if applied in strong solu- 
 tion to the tender skin of a new-born child, will very frequently 
 abrade the cuticle to a very large extent ; it should, therefore, 
 never be employed. It is better to wash the child with plain 
 warm water, than have recourse to this soap. 
 
 192. During the whole process of washing, the child should 
 be exposed as little as possible to a current of air; and, if the 
 weather be cold, it should be dressed near the fire. 
 
 Sect. II.— Of the Dress of the Child. 
 
 193. The dress of the child should always be made subservient 
 to comfort. If this rule be acted. upon, it will be found to con- 
 sist, 1st, in such arrangements of it, as shall sufficiently protect it 
 agains cold,* and, 2dly, to ensure it against all inconvenient, and 
 
 * It is a very common error to suppose, the tighter the clothes are wrapped 
 round the child, the warmer it will be kept; but this is not so, for warmth will 
 always be increased by leaving the child's limbs rather free, as its motions then 
 will contribute to its warmth. 
 
 10 
 
74 OF DRESSING, &C, TJHE CHILD. 
 
 injurious pressure and restraint, as well as producing loo mucfr 
 heat ; therefore, the cruel practice of swaddling should be for 
 ever laid aside. 
 
 194. For this absurd practice, it would, perhaps, be difficult 
 to assign a reason; it probably, however, arose from the inroads 
 made by the rickets upon the proper form .of the human limbs — 
 mistaking the effect of disease for a defect of nature ; and thus 
 applying a partial remedy for the morbid condition of the whole 
 constitution. In times of ignorance, when the care of women 
 was entirely confided to females, this injurious practice may have 
 originated in a false theory; and it was certainly perpetuated 
 by the designing midwife. For, though every child was not born 
 with a disposition to rickets, yet it is probable that these selfish 
 women persuaded their patients, that the limbs of all children 
 would become so, if not guarded against by proper management. 
 This opinion seems in part confirmed, by this practice being in 
 a degree abolished, as soon as midwifery became generally prac- 
 tised by men ; for we never hear of an accoucheur performing 
 this terrible ceremony for the poor child. 
 
 195. Buffbn says, " With us (in France) an infant no sooner 
 leaves the womb of its mother, and has hardly enjoyed the li- 
 berty of moving and stretching its limbs, than it is clapped again 
 into confinement. It is swathed, its head is fixed, its legs ar,e 
 stretched out at full length, and its arms placed straight down 
 by the side of its body. In this manner, it is bound tight with 
 clothes and bandages, so that it cannot stir a limb: indeed, it is 
 fortunate that the poor thing is not muffled up so as to be unable 
 to breathe ; or, if so much precaution be taken as to lay it on its 
 side, in order that the fluid excretions, voided at the mouth, 
 may descend of themselves ; for the helpless infant is not at li- 
 berty to turn its head to facilitate the discharge."* 
 
 196. Can any thing be running so entirely counter to the dic- 
 tates of nature? Let us consider the poor infant folded up in 
 the smallest convenient form in its mother's womb, for the pe- 
 riod of nine months; and then let* us watch its movements as 
 soon as it is free; and we shall at once be convinced, by the 
 stretching of its little limbs in every direction, how much it en- 
 joys its liberty. 
 
 197. Analogous to the unnatural restraint imposed upon the 
 
 * Hist. Nat, torn. iv. 190, 12mo. 
 
OF DRESSING, &C, THE CHILD. 75 
 
 limbs by bandages, we may reckon on the common practice of 
 even the present day, of pinning the ends of its garments close 
 up to the feet of the child ; thus preventing all movements of its 
 limbs. This should be guarded against, by the mother forbid- 
 ding the nurse to dress the child after this fashion. If the ends 
 of the clothes must be turned up, let sufficient room be given 
 for the exercise of the child's limbs. In the same way, all mo- 
 tion is prevented to the arms by their being confined by a nap- 
 kin, when the child is laid down ; this is done under the spe- 
 cious pretext of preventing the child from scratching itself with 
 its nails, as it cannot command the direction of its hands. 
 
 198. It would be useful to the poor infant to have the use of 
 its limbs, even at the expense of an occasional scratch from its 
 own nails ; since, by their exercise, they would become strength- 
 ened, and, in a short time, the child would learn to direct them 
 properly by a gradually increasing experience. We would, 
 therefore, forbid every restraint to the motion of the limbs, 
 body, and neck of the child ; and thus permit them to exercise 
 their little muscles in any direction or degree they might choose. 
 In cold weather, the arms may be covered to encourage warmth, 
 but they should never be fixed down. 
 
 199. It is to this freedom of the limbs, that the child is in- 
 debted for its increase of strength, and its eventual power to 
 walk ; and to it does it owe the preservation of the due vigour 
 of the antagonizing muscles. For when but one set of muscles 
 is employed, the antagonizing set become weakened ; and, if too 
 long persevered in, sometimes even useless. We once saw a 
 child, who had been made to nurse itself almost from its birth, 
 lose the power of the extensor muscles of .the legs, by its being 
 obliged to sit for many hours together in one spot upon a hard 
 floor. This child could never stretch its legs sufficiently straight 
 to learn to walk, and died a cripple at the age of seven years. 
 
 200. Proper attention has rarely been paid, either to the ma- 
 terials, or the form of the articles of clothing, for a new-born 
 child. They have, generally, been made of the same kind of 
 stuff, whether the child be born in winter or in summer — this 
 surely cannot be required. In general, however, the error has 
 been on the safer side; for, if the child have suffered, it has ra- 
 ther been from an unnecessary, than from a deficient quantity of 
 clothing. But errors of every kind should be removed when 
 
76 OF DRESSING, &C, THE CHILD. 
 
 practicable ; therefore, we would not have more clothing heaped 
 upon the child than shall be necessary to protect it against the 
 existing cold. 
 
 201. This adjustment, however, requires much care, and 
 should be effected by those of good judgment, though not pre- 
 cisely for the reasons assigned by Dr. Buchan, who says,* that 
 "every child has some degree of fever after birth; and, if it be 
 loaded with too many clothes, the fever must be increased often 
 to such a degree, from the concurrence of other causes of heat, 
 as to endanger the life of the child. Even though no fever 
 should be excited, the greatest debility must be the consequence 
 of keeping the child in a state of perpetual waste by excessive 
 perspiration. Besides, in such a condition, the child is liable to 
 catch cold upon exposure to the least breath of air; and its 
 lungs, relaxed by heat, and never sufficiently expanded, are apt 
 to remain weak and flaccid for life, so that every cold will have 
 the most alarming tendency, and probably terminate in asthma 
 or a consumption." 
 
 202. The Dr. has really drawn a frightful picture of the ef- 
 fects of too much clothing upon a young child; but it is one we 
 cannot recognise from experience, nor acknowledge from theory. 
 We admit, that should the child be so abundantly clothed, as to 
 keep it in a constant state of perspiration, there might be a risk 
 of its catching cold upon exposure, or much weakened. But we 
 are of opinion, if mothers should take the alarm from this repre- 
 sentation, they might do much worse, by running into the contra- 
 ry extreme ; and Dr. Buchan himself would confess, too thin 
 clothing might be attended with worse consequences than too 
 thick. Besides, we do not agree with the Dr. in the premises he 
 starts with, namely, that " every child has some degree of fever 
 after the birth." 
 
 203. We should be very careful how we admit this position, 
 as it would lead to very wrong practice. That a new-born 
 child, like another individual, might have fever as an accidental 
 circumstance, we admit ; but, as a necessary consequence of its 
 birth, we deny — first, because it would seem an extraordinary 
 arrangement of nature, that every child should be ushered into 
 existence m a state of disease; for fever is disease; and a dis- 
 ease of a formidable kind; 2dly, we have never witnessed this, as 
 
 * Advice to Mothers, p. 110. 
 
OF DRESSING, &C., THE CHILD. 77 
 
 a sequerice of birth. Therefore, withholding a sufficiency of 
 clothing, with a view to counteract, or to not augment an ima- 
 ginary disease, would, to say the least, be idle. 
 
 204. That new-born children may be improperly dressed, 
 and improperly managed after they are dressed, we believe, 
 nay, know ; but the state of perspiration which the Dr. so much 
 dreads is owing, we believe, almost always, in cold weather, to 
 their being placed under too many bed clothes. On this account, 
 we would caution against both extremes ; but not because the 
 child has fever ; nor from an apprehension of the evils which 
 are supposed to follow a state of perspiration. As this is a mat- 
 ter of consequence, as every truth is that is connected with the 
 welfare of infants, we shall say a few words upon the supposed 
 consequences of this over-dressing. 
 
 205. The doctor says the child is «* liable to catch cold upon 
 exposure to the least breath of air :" this is admitted, if the child 
 be in a state of perspiration, and be improperly exposed ; but this 
 would be the case, did the perspiration proceed from an over 
 quantity of bed-clothes; and as it would be important to deter- 
 mine from which of these sources the evil proceeded, it would 
 be well to give it a fair invest igalion; and to ascertain, if possi- 
 ble, to which of the causes the error belongs. Therefore, should 
 the child be moist, though exposed to the air, it might justly be 
 attributed to a solution of fever; but if it only perspired when 
 closely covered, we would be certain it proceeded from an ex- 
 cess of clothing. We have, however, considered it sufficiently 
 difficult in most cases to excite perspiration upon the skin of a 
 new-born child, by almost any means ; and for this plain reason 
 — it is some time before the vessels upon the surface become 
 sufficiently active, and filled, or the circulation sufficiently pow- 
 erful to produce this effect. Examine the skin of a new-born 
 child, and you will find it almost constantly cold, unless well 
 protected by clothing made of materials which are bad conduc- 
 tors of heat — and hence the, absolute necessity of maintaining 
 this condition by suitable means. 
 
 206. The Dr. also says, that " the child's lungs are relaxed 
 by heat !" If this be so, how is it possible to prevent it ? If 
 heat be improper to the lungs, all animals that haj#e hot blood 
 must be precisely in the same situation ! for the Dr. would not 
 deny that warmth is essential to the existence of man; and if 
 this be so, the lungs, like every other internal part, must have 
 
78 OF DRESSING, &C, THE CHILD, 
 
 an equal temperature, and no more : now, how a temperature, 
 which scarcely varies a degree at any season of the year, and 
 which is natural to the human body, and inseparable from it in 
 the living state, shall produce relaxation of the lungs, we can- 
 not possibly understand. 
 
 207. He farther states, " they (the lungs) are never suffi- 
 ciently expanded, and are apt to remain flaccid for life." We 
 would ask, why the lungs are never sufficiently expanded? Be- 
 cause the lungs are relaxed by heat, we suppose must be the an- 
 swer from the premises ! Now, it would seem from this, that 
 our notions upon the expansion of the lungs must have been 
 wrong, since heat is unfavourable to it, by producing relaxation 
 of them. We have often heard of, and we believe we have 
 seen, the sudden application of cold interrupt the full expansion 
 of these bodies ; but we have to learn that heat does so, by pro- 
 ducing relaxation in them. To our mind, this relaxation, if it 
 exist, should favour expansion, since it implies less resistance. 
 
 208. In winter, or even in cool weather, flannel must form 
 a part of the child's clothing; especially their little shirts, and 
 petticoats ; but this should be of such fineness, as not to oppress 
 either by its weight or its thickness. It should always be of 
 the white kind, where the circumstances of the parents will 
 permit it — not that the first cost of the white need be greater 
 than that of the coloured, but because it will, for the sake of the 
 eye, require to be more frequently changed, as it will more rea- 
 dily show any dirt that may attach to it ; but for this very rea- 
 son, it should be employed, whenever it is practicable. Ano- 
 ther reason may also be assigned ; the white can always be pro- 
 cured of a finer quality, which sometimes is desirable. 
 
 209. There is a very common error upon the subject of flan- 
 nel, which deserves to be corrected ; namely, that it can remain 
 longer dirty without doing mischief by its filth, than any other 
 substance ; but in this there is no truth — flannel, from its very 
 texture, is capable of absorbing a great deal of fluid, which' it 
 will retain so long, if permitted, as to allow a fermentative pro- 
 cess to go on, and give rise to the extrication of some deleteri- 
 ous gases ; therefore, flannel should not be worn even so long, 
 on this very account, as linen substances. The principal ad- 
 vantage in the use of flannel is, its non-conducting property of 
 sensible heat — it is, therefore, well calculated to protect the 
 body against the too rapid escape of this important fluid. 
 
OF DRESSING, &C, THE CHILD. 79 
 
 210. Agreeably to these views, flannel should be used when- 
 ever it will be proper to accumulate heat, by preventing its too 
 rapid dissipation from the body ; it should, therefore, be employed 
 precisely in the proportion that these ends require. But it will 
 be readily seen, that no precise quantity can be directed ; since 
 the degree of necessity will be constantly varying as tempera- 
 ture may alter, or as a constitution and period of life may change. 
 As a general rule, it may, however, be observed, that the 
 younger the child is, the more of this article is required ; but it 
 should never be in such quantity as to create a vapour bath. 
 
 211. There is another operation of flannel, that is highly 
 valuable, especially in this variable climate ; and its agency in 
 this respect may be considered as one of almost indispensable 
 necessity — it is its protecting power against sudden reductions of 
 temperature. By virtue of its non-conducting power, the system 
 is saved from a prodigious expense of caloric, or heat, at a time 
 when its sudden escape might be attended with effects of the 
 most serious kind — the advantages of flannel in this respect are 
 familiar to every one ; for every body adopts the practice, with- 
 out exactly understanding the principle on which it is founded. 
 Again, it powerfully guards the body against the cooling effects 
 of evaporation, when in a state of perspiration; and by prevent- 
 ing its too sudden escape, it keeps a considerable portion of heat 
 constantly applied to the surface of the skin, by means of this 
 vapour ; and thus hinders it from leaving the body too suddenly. 
 
 212. Flannel may also be regarded as a very pleasant and ex- 
 tensive " flesh brush;" by constantly giving to the skin a gentle 
 and an agreeable irritation. By this means the insensible per- 
 spiration is freely maintained; while all the evils arising from a 
 check of the sensible, are very much guarded against. 
 
 213. It must nevertheless be admitted, that the utility of flan- 
 nel has its limits; beyond which its employment should not 
 be urged. Flannel may 'be improper, 1st, where it excites too 
 much perspiration, as in young children, sometimes during the 
 extreme heats of our summers — when this is observed, it should 
 be removed, and a similar garment of muslin, or even linen, 
 should be substituted. The flannel should, however, be imme- 
 diately replaced, whenever an alteration in temperature may 
 render this proper. Indeed, the only proper direction that can 
 
80 OF THE BELLY BAND. 
 
 be given for the dressing of the children during our summersy 
 is to vary the clothing with the variations of the thermometers 
 This, it is true, may occasion some additional trouble to the pa- 
 rent; but the observance of it, it should be remembered, gives- 
 additional security to the health of the child; for we are entire- 
 ly convinced, that very young children suffer extremely, and 
 are sometimes even rendered ill, by their bodies being too mucli 
 loaded with flannel. 
 
 214. 2dly, Flannel may also be improper, from idiosyncrasy 
 — this should be carefully attended to; as the child has been 
 known occasionally to suffer much from this peculiarity. It? 
 may readily be detected, by the child almost constantly express- 
 ing uneasiness, without any obvious cause; and by an efflores- 
 cence spreading itself over the body, which immediately dis- 
 appears so soon as the flannel is removed. 
 
 215. 3dly, Flannel may also be improper, during a febrile 
 condition' of the system ; it should, therefore, always be removed, 
 when it may be desirable to lower the temperature of the skin. 
 We are well aware, that this will appear extraordinary advice 
 to many ; and there may be even strong prejudices against the 
 practice. But we fear no reproach upon this head ; as it has been 
 justified, a hundred times, in our own practice. The fear of 
 "catching cold," as it is called, should not prevail against it,, 
 since you cannot ingraft a slighter disease upon a stronger.* — 
 
 Sect. Ill— Of the Belly Band. 
 
 216. This useful appendage to the child's dress should be 
 of flannel ; but it should be made single; it should be worn, until 
 the child is at least four months old ; or even for a longer period,- 
 
 * It may not be amiss to suggest, not only the utility, but the absolute luxury 
 to the child, of friction upon its abdomen, with the bare warm hand, for a minute 
 or two every time it is dressed. This exercise is so grateful to the child, that it 
 never fails to express its delight, by its smiles, cooings, and the stretching of its 
 limbs. We would, therefore, always recommend this practice, since it not only 
 delights the child, but, also, promotes the healthy action of its bowels. 
 
 In summer, flannel is frequently found to be oppressive, as well as irritating. 
 In such cases, we have lately found silk shirts to be highly grateful as well as 
 useful. We would, therefore, recommend its employment in all instances in 
 which the flannel is found to disagree, or where it is thought to be ineligible. 
 The substance, known by the people of trade under the name of cancon, is ex- 
 cellently well adapted for the purposes here proposed. 
 
OF THE BELLY BANi>. 81 
 
 if the child be feeble, or has a tendency to umbilical hernia. 
 This article is of great importance, and should never be omitted; 
 but care is required in its application, that it do not produce the 
 evils it is intended to prevent. The object of a belly band is to 
 give a general support to the abdomen, and a particular one to 
 the naveL The propriety of using it for the first object, will be 
 obvious to every body, at first sight. It protects the external 
 covering of the belly from being suddenly and partially distended, 
 in the actions of crying, coughing, and sneezing ; and, by this 
 means, pain, or more serious evil, is prevented. 
 
 217. But the necessity and utility of the second, if equally im- 
 portant, is certainly not as well understood. The umbilical cord, 
 by means of which the child is nourished during its residence 
 within the uterus, is composed of several vessels, which enter 
 into, and depart from, the belly. The passage of these vessels 
 requires a hole entirely through the covering of the bowels, which, 
 for the most part, closes very quickly and soundly, after the se- 
 paration of the navel. But several circumstances, on the part 
 of the child, may'interrupt this natural process ; and, when these 
 happen, they give great liability to a portion of the bowels, or of 
 the omentum, to be forced through this imperfectly closed open- 
 ing, from any strong and sudden conquasitory motion, as crying, 
 coughing, sneezing, or straining. , 
 
 218. The circumstances, on the part of the child, which may 
 give rise to, or increase this liability to a " rupture " at this part, 
 are, 1st, an unusual size of this opening, as an original conforma- 
 tion ; 2dly, the want in the part of a healthy disposition to close; 
 3dly, an interruption being given to the natural process of closing, 
 by the crying, &c, of the child, forcing the intestine, or omen- 
 tum, frequently against it. 
 
 219. It will follow that this part, being weak from its very or- 
 ganization, will require a steady and continued protection, that 
 the accident of " rupture," may not take place. 
 
 220. For this purpose, the belly band has been used from time 
 immemorial ; but its mode of action is not well understood by 
 those who apply it to new-born children. It is wrongly ima- 
 gined that the tighter this bandage is drawn over the part, the 
 greater is the security against the evil it is intended to prevent — 
 than which no greater error can exist, as will be evident to any 
 
 11 
 
82 OF THE BELLY BAND. 
 
 one who will consider the following account of the structure of 
 these parts. 
 
 221. 1st, The cavity of the abdomen may be considered as 
 completely filled, or occupied by its contents ; 2dly, that the ab- 
 dominal cavity is formed without any absolute outlets, or com- 
 munications with the external air ; but has openings leading to 
 other cavities, as those of the scrotum in males, but into which 
 it is not intended, as a natural arrangement, that any portion of 
 the abdominal viscera shall enter; and also, the one already de- 
 scribed as existing at the umbilical ring. 
 
 222. Now, when the capacity of this cavity is diminished, or 
 severely restricted, as it necessarily must be by the diaphragm 
 being forced powerfully downward, and severely pressed on all 
 sides by the abdominal and lumbar muscles, as must necessarily 
 happen in the actions of crying, sneezing, coughing, or straining, 
 that the contents of this cavity must be constrained, and power- 
 fully pressed against every part and portion of its internal face; 
 and if there be any one portion of the surface weaker than ano- 
 ther that part must necessarily yield, if the force be greater than 
 that part can sustain. It will, therefore, follow, as a matter of 
 course, that the scrotal, and the umbilical openings just men- 
 tioned, being naturally weaker points in this cavity, they will, 
 and must yield, when the impulses just named shall be greater 
 than the powers of resistance, 
 
 223. From what has been said, it will readily be admitted, that 
 any arrangement of dress which shall diminish the cavity of the 
 abdomen, must have a tendency to do mischief, in the way we 
 have just pointed out; therefore, the belly band may become an 
 agent of this kind, if not properly applied — hence, it becomes an 
 important part of a mother's duty, to attend, at each dressing of 
 the child, that the band be not too tightly drawn. 
 
 224. Evils of a lesser kind oftentimes follow the improper ap- 
 plication of this article of dress ; namely, pain, arising from com- 
 pression, and colics, from the want of room for the bowels to ex- 
 pand. The inconveniences enumerated above, as arising from 
 too strict an application of the belly band, suggest the import- 
 ance of this article being as elastic as will be compatible with 
 security — we, therefore, would direct that it should be made of 
 a piece of flannel, cut "bias," as the women term it, in order 
 that it may possess this property. 
 
OF THE BELLY BAND. 83 
 
 225. The disease, against which we have been suggesting a 
 prevention, so far as dressing may be concerned, is of more fre- 
 quent recurrence than could well be imagined by one who had 
 not made it a subject of inquiry; and, when it takes place, is of 
 much more serious consequence than might, at first sight, be sup- 
 posed : therefore, to prevent it, is of the first consequence. 
 
 Sect. IV. — Of the general Dress of the Child. 
 
 226. The other articles of a child's dress, may be regulated in 
 such a manner as will give sufficient security against too low a 
 temperature in winter, or as shall not oppress in summer ; there- 
 fore, the petticoats for winter, fall, and spring, should be made of 
 flannel, and of such length as shall cover their limbs with cer- 
 tainty. Flannel may, however, be occasionally useful in sum- 
 mer, especially on sudden changes of the weather, and should al- 
 ways be resorted to upon such emergencies ; for there can be no 
 greater error committed in dressing a child, than to regulate its 
 clothing exclusively by the almanack, or, sometimes, even by the 
 thermometer. The feelings alone should determine the quantity 
 and quality of them, during either midsummer or winter. If 
 these be made the rule, we shall find it very often important to 
 vary the articles of clothing, in our unsteady climate, two or three 
 times within four and twenty hours. 
 
 227. The length of the child's clothes is, by no means, a mat- 
 ter of indifference. After it has arrived at its eighth or ninth 
 month, they should be shortened, so as to leave the feet and an- 
 kles free. By this plan, the child will use its limbs earlier, and 
 to more advantage, since they will not be fettered by the restraint 
 of long dresses. The muscles will acquire more firmness and tone, 
 and be more obedient to the command of the will ; they will also 
 be exercised regularly, and the flexors and extensors will have 
 their just proportions of power, so that when the child begins to 
 walk, it will be able to balance itself much sooner, and more 
 successfully. 
 
 228. Some, perhaps, will object to this arrangement, especially 
 in winter, from an apprehension that the feet and legs may suffer 
 from cold — but this objection is easily removed, by covering these 
 parts with their appropriate garments. 
 
 229. We are aware that this last objection is not in conformity 
 
84 OF THE GENERAL DRESS OF THE CHILD. 
 
 with some writers upon this subject. We know that stockings 
 are forbidden by them for two reasons ; 1st, because they will 
 injure the child, by becoming wet ; and* 2dly, because they will 
 make it too tender. 
 
 230. To the first we would declare, that, upon this principle, 
 the child should have no clothing whatever, since all is exposed 
 to the same accident ! The diapers, the petticoats, &c, should 
 be abolished, since they must often become wet in the course, of 
 the day ; yet we hear nothing of injuries arising from this source. 
 When these articles are wetted, care is taken that they are dried 
 before they are again used, or their places supplied with fresh 
 articles; and why should not the same attention be extended to 
 the stockings? As regards the second objection, the reasons we 
 have urged against all unnecessary exposure of the person of 
 the child, will apply here ; and, therefore, we shall not repeat 
 them. 
 
 231. Shoes are condemned* because they are said, 1st, to cramp 
 the feet and embarrass their motion ; 2dly, that the child does 
 not learn to walk so early as when they are exposed. These 
 are very far from being solid objections to the use of shoes, since 
 the first may be removed by their being made large, and of the 
 most pliant materials ; and as they afford protection from cold, 
 and security against accident, when the child is placed upon the 
 floor, we are decided advocates for their employment, especially 
 upon carpeted floors, where pins, needles, or other sharp sub- 
 stances, are very often effectually concealed, by their being bu- 
 ried in the substance of the carpet. 
 
 232. The second objection has, perhaps, less force than the 
 first ; since we have ever held the opinion that no advantage is 
 gained by a precocious power to walk. Indeed, we hold this to 
 be very often injurious, especially to such children as may be 
 disposed to 'rickets. We shall have occasion again to mention 
 this subject ^^ s 
 
 233. We have said that the shoes maybe so constructed as to 
 do no injury to the child. Th'kjs strictly true, and should always 
 be conformed to; but the,plan proposed, (we believe, originally, 
 by Faust, in his Catechism c^Health^ merits the attention of 
 every parent ; namely, having shoes made upon two different 
 lasts, one for each foot, as is now .pretty generally done in this 
 city. We object very much to*the advice of Struve upon this 
 
OF ''THE GENERAL DRESS OF THE CHILD. 85 
 
 • 
 
 subject — he recommends children to lay aside shoes for a short 
 period at a time, that the feet may be better expanded. This is 
 certainly bad advice; as most children would be subject to seri- 
 ous colds, by this plan, if not to dangerous disease. 
 
 234. In winter and in cool weather, we follow the proper 
 plan almost instinctively, as regards clothing ; for we accommo- 
 date the quantity by our feelings, without regarding the state of 
 the mercury in the thermometer. Precisely the same should be 
 done in summer — the relative heat, or cold, 'should be our guide. 
 
 235. The principal articles of clothing are to be made of fine 
 flannel — they are generally called the under clothes — fashion, 
 caprice, or fortune, may regulate the rest, provided the gar- 
 ments for the feet and legs are excepted. We hold it to be of 
 great importance that both of these be kept warm in winter; 
 and the feet even during summer. We, therefore, direct mea- 
 sures to protect these parts of even very young children. We 
 shall have occasion, by and by, to revert to this subject. 
 
 236. There is, however, a constant necessity to guard the child 
 against the accidental and partial application of cold from wet, 
 which is always occurring, from the very nature of things. The 
 child should, therefore, be dried as quickly as possible after it 
 may have become wet, by a speedy renewal of the diaper. A 
 monstrous error prevails upon this subject; an error every way 
 calculated to produce great disquiet and inconvenience, if not 
 positive disease. It is imagined, that inuring them to wet con- 
 tributes to the future health of the infant, or, in other words, that 
 it must remain wet and cold, that it may become hardened in 
 constitution by this filthy process. The absurdity of this prac- 
 tice is at once exposed, by asking, is there a mother who would 
 apply cold, wet cloths to her child, with a view of hardening it, 
 though she might be willing to let it wallow for a long time in 
 its fifth? 
 
 237. It may, however, be said, these are not parallel cases ; 
 for the urine of the child can do no harm, as it is salt water. 
 We admit it to be saline — what then? Will any woman apply 
 cold, salt water to her child, for the purpose, and in the manner, 
 we have just mentioned? But it may be said, the water is warm 
 when it first touches the child, and becomes cold afterwards ! 
 So much the worse — but will any rational mother apply warm 
 
86 OF THE GENERAL DRESS OF THE CHILD. 
 
 salt water to her child, and suffer it to grow cold, in expectation 
 of benefiting it? We are certain, every one of proper feeling 
 will say, No! 
 
 238. The employment of too many pins in the dressings of the 
 child, is also occasionally attended by much risk, especially when 
 small ones are used — -the latter kind should be banished altoge- 
 ther from the nursery, as they cannot ever be necessary, and 
 may, as has frequently happened, be seriously injurious, by. slip- 
 ping into the folds of the skin, or joints of the child ; or they may 
 create a great deal of immediate pain, by their partial penetra- 
 tion into the skin. The clothes of the child can readily be so ar- 
 ranged as to do away with the necessity of these articles; or, at 
 least, the quantity may be very much diminished. When many 
 are employed, they are constantly liable to be displaced, and 
 may, consequently, wound the child, 
 
 239. In general, nurses are in the habit of using from eight 
 to twelve pins, for the dressing of the child ; a quantity every 
 way too great for even usefulness, did no risk attach to their 
 employment; especially as the same ends can be completely an- 
 swered by two, as was the regular practice in our own family. 
 It is true, that, to render so few efficient, strings or tapes must 
 be used in their stead. The following is the mode employed : 
 The belly band and the petticoats have strings; and not a single 
 pin is employed in their adjustment. The little shirt, which is 
 always much larger than the infant's body, is folded on the back 
 and bosom, and these folds kept in their places, by properly ad- 
 justing the body of the petticoat — so far, not a pin is used. The 
 diaper requires one; and this should be of a large size, and made 
 to serve the double purposes of holding the folds of this article, 
 as well as keeping the belly band in its proper place ; the latter, 
 having a small tag of double linen depending from its lower mar- 
 gin, by which it is secured to the diaper, by the same pin. 
 Should an extraordinary display of best "bib and tucker" be 
 required, upon any especial occasion, a third pin may be admit- 
 ted, to ensure the well sitting of the "frock" waist in front — 
 this last pin, however is applied externally; so that the risk of 
 its getting to the child's body is very small, even though it be- 
 come displaced. 
 
 240. Especial care should be taken that needles be not used 
 instead of pins; this substitution we have witnessed; and the 
 
OF THE GENERAL DRESS OF THE CHILD. 87 
 
 risk in this case is much greater, as these articles have no heads. 
 The most serious consequences have sometimes followed their 
 use : I will relate a case every way in point. In the year 1798, 
 we were requested to examine the child of Mr. J. H. B. — who, 
 we were informed, had been for many months in ill health ; it 
 occasionally suffered the most excruciating agony, without any 
 evident cause, and which could not be relieved but by large and 
 repeated doses of laudanum. The child was said to cry out vio- 
 lently upon certain motions of its body, and especially, upon 
 moving its right leg ; upon the upper part of which there was a 
 hard substance, which, upon being pressed, gave pain. 
 
 241. The child was about two years of age; and had been al- 
 ways a very healthy one until the last preceding seven or eight 
 months. At about this time, it was discovered to be fretful, 
 feverish, and indisposed to exercise! It would, occasionally^ 
 scream violently; and would sometimes cease to cry, as sudden- 
 ly, without any evident cause. At other times, the pain would 
 continue, until it was controlled by the use of laudanum. It lost 
 its appetite, emaciated rapidly, and had more or less fever con- 
 stantly. 
 
 242. This was the history we received, upon our first visits 
 from the mother of the child. We found the child very much 
 reduced, with considerable fever, and a profuse diarrhoea. We 
 examined the part that was said to be painful, and found it to 
 present a remarkable feel to the touch, as well as a singular ap- 
 pearance to the eye. It was placed immediately upon the tuber 
 of the right ischium, or that part of this bone on which we siL 
 It was considerably swollen; so much so, as to offer a strong, 
 contrast to the opposite one, which was very much emaciated. 
 When this was pressed, the child would complain; it was firm, 
 and resisting; and if the fingers were made to grasp it, it seemed 
 to contain another very firm and long tumour within it ; giving 
 the sensation to the fingers, of a pretty long piece of bone, 
 placed perpendicularly to the surface of the tuber of the is- 
 chium. 
 
 243. We told the mother, there was unquestionably an ex- 
 traneous substance beneath the skin ; the nature of which we 
 could not pretend to determine ; but our impression was, it was a 
 needle ; and that nature had set about a process for its liberation? 
 in which, she would certainly succeed in due time, should the child 
 
88 OF CHANGING THE CHILD. 
 
 have sufficient strength to support the irritation necessary for 
 this event: but this was a circumstance we very much doubted, 
 as the child was not only very feeble, but very ill at that mo- 
 ment, from fever, lax, &c. We, therefore, proposed an opera- 
 tion, as a speedier and safer plan—it was instantly consented to. 
 We made an incision with a scalpel, immediately upon the point 
 of the inner tumour, from which issued about a tea-spoonful of 
 a transparent, and pretty tenacious fluid, resembling the white 
 of an egg ; but not quite so thick. Upon placing a finger upon 
 the incision, and gently pressing it against the tumour, we felt a 
 hard pointed substance directly in its centre; this was seized 
 with a pair of forceps, and we drew from it a needle full two 
 inches long. The wound was dressed with a little slip of stick- 
 ing plaster, and healed in three days ; ! the child from that mo- 
 ment had not an unpleasant symptom. The hectical diarrhoea 
 ceased ; as did the fever ; and in a few weeks the child was re- 
 stored to perfect health, without the aid of any medicine. 
 
 244. How, or when this needle got possession of the child's 
 system, could never be determined — it is presumable, it was in- 
 troduced by its being employed as a pin. 
 
 Sect. V. — Of Changing the Child, 
 
 245. There is a diversity of opinion respecting the necessity, 
 or propriety of frequently changing the dress of a child after it 
 becomes wet. Upon this subject, there should be but one opi- 
 nion ; and this should become a maxim, from which there should 
 be no departure; namely, that the child should never be long 
 wet, or dirty, at a time. The healthiest children we have ever 
 seen, were those on whom the greatest care was bestowed ; 
 especially when they were very young; and it is to that period 
 we now have more particular reference. If frequent changing 
 be not had recourse to when the child is wet, there can be no 
 security for the continuance of health ; every time it is permitted 
 to remain wet, it incurs the risk of taking cold, besides pro- 
 voking inflammation, or producing excoriations ; whereas, drying 
 the child, as often as it becomes wet, will prevent these evils. 
 
 246. But it should be well understood, when we speak of 
 keeping the child clean, that we do not consider the repeated re- 
 application of the same diaper, because it has been hung in the 
 
OF FEEDING THE CHILD IN THE MONTH, &C. 89 
 
 air, or before a fire and dried, as coming within our direction. 
 There can be but two reasons for this filthy practice— laziness, 
 and poverty. The first, should never be considered as a valid 
 excuse for employing the same diaper several times, nor will it; 
 perhaps, ever be urged as one, in direct terms; but it is, unques- 
 tionably, the only one that influences upon this subject, where 
 the second does not obtain, to render this, even in appearance, 
 excusable. If the second reason exist, and the child have riot a 
 sufficient change, it were much better that it be without a dia- 
 per from time to time, than have those returned to it stiffened 
 with salts, and reeking with offensive odour. We have already 
 adverted to the impropriety of keeping the child wet. 
 
 CHAPTER XIV. 
 
 OF FEEDING THE CHILD IN THE MONTH, &c. 
 
 247. Our fifteenth instruction, (106) is one of much import- 
 ance to the future health and happiness of the individuals for 
 whom it is intended; for no one of the errors we have attempted 
 to correct, is so frequently and so mischievously infringed. We 
 have assumed as principles, and, as we think, upon broad and 
 well established data — 1st, that the mother is the proper and 
 only source from whence a child, until a certain period, should 
 derive its nourishment; 2dly 5l| that every woman, cceteris paribus, 
 is able to furnish it ; 3dly, that no other nourishment is so entire- 
 ly proper, as the milk of a healthy mother. 
 
 248. If these premises be correct, the subject of feeding chil- 
 dren within the month, is reduced nearly to a prohibition, where- 
 ever there is no exception to the above rules. Yet there may be, 
 indeed there often is, a propriety in giving a young child some- 
 thing to sustain it, when there is not a sufficiently early provi- 
 sion made by the breasts of the mother for this purpose ; but it 
 should consist of an article as near in composition as possible, to 
 the mother's milk. This object is readily attained by a mixture 
 of cow's milk, water, and loaf-sugar, in the following proportions 
 
 12 
 
90 OF FEEDING THE CHILD IN THE MONTH, &C. 
 
 milk two-thirds, water one-third, and a small quantity of loaf- 
 sugar. This may be given from time to time, until the mother 
 is able to furnish a sufficiency ; or, when she has not enough, it 
 may be made to supply the deficiency. 
 
 249. This diet alone should be made use of; for every thing 
 else, is not only less proper, but oftentimes absolutely injurious. 
 No addition should be made, under the expectation of making it 
 more fit, or more nourishing ; for every such addition renders it 
 less useful, if not hurtful — we, therefore, proscribe every mixture, 
 or combination, except the one just mentioned. We are aware 
 we do not agree with the judicious Dr. Struve* upon this point 
 — he directs, in cases of deficiency of milk on the part of the 
 mother or nurse, that this want should be supplied by a "pap 
 prepared of bread perfectly baked, or, what is still better, bis- 
 cuits boiled in. water, or fresh milk, to the consistence of thin 
 gruel." We unhesitatingly declare, we have ever found this to 
 be a bad practice ; and the Dr. himself would seem to bear tes- 
 timony against it, in another place ;f for he says, "many mothers, 
 and nurses in general, imagine that a child cannot be supported 
 by the breast alone, and, therefore, ought to be allowed a more 
 substantial nutriment. Impressed with this erroneous notion, 
 they provide the usual pap almost as soon as the child is born ; a 
 species of food directly opposite to that, which is appointed by 
 nature, and derived from a healthy mother ; hence it cannot fail 
 to prove injurious." 
 
 250. "From this pernicious practice," continues the Dr., 
 " arise inflations of the lower belly, gripes, and costiveness. — 
 Such children become afflicted with insupportable pains in the 
 bowels, the iliac passion, and subsequently with rickets ; they 
 obviously lose strength, and muscular energy, notwithstanding all 
 the care of plentiful feeding; their, skin loosely covers their 
 bones," &c. This is truly a hideous picture ; but it is neverthe- 
 less true ; yet, with this before him, he did not fail, two pages 
 after, to recommend this very substance. 
 
 251. Every' farinaceous substance in a state of fluid mixture, 
 is liable to become acid; or to ferment when heated, even by a 
 lower temperature than that of the human body, if sufficiently 
 long continued ; consequently, the child must experience all the 
 
 . * Physical Education, &c. p. 224. f Ibid. p. 222. 
 
OF FEEDING THE CHILD IN THE MONTH, &C. 91 
 
 evils which may follow such changes, when they take place in 
 the stomach, therefore, all such substances must be highly im- 
 proper. It may, however, be asked, will not the mixture just 
 proposed, be liable to the same objection? We say, No — at 
 least, not to the same extent, as the other; for if the milk be 
 sweetened no more than to correspond in degree with the mo- 
 ther's milk; if it be sweetened with loaf-sugar, and given as 
 soon as mixed, there will be very little disposition in it to change 
 before the stomach will exert its influence upon it, and convert 
 it into a new substance.* 
 
 252. To make, however, the mixture of milk, water, and su- 
 gar, always acceptable to the child's stomach, several highly im- 
 portant rules should be observed, and never departed from, when 
 it is practicable to observe them. 
 
 253. 1st, The milk should be pure ; that is, not skimmed, nor 
 previously reduced by water ; and should be used as quickly as 
 possible, especially in warm weather, after it has been drawn 
 from the cow. 
 
 254. 2dly, When practicable, it should always be taken from 
 the same cow. The reasons for this injunction are, that cows, 
 feeding upon the same materials, give different qualities of milk; 
 and the stomach becomes reconciled very often more readily to 
 any one certain quality, than to a mixture. 
 
 255. 3dly, The milk should be given as soon as possible after 
 its mixture with the water and sugar, lest it should be disposed 
 to ferment, before it is exhibited. 
 
 256. 4thly, It should never be mixed, but when wanted ; and 
 no more should be provided than the child will take in a short 
 
 * Dr. Cadogna says, "There are many faults in, the quality of the food of chil- 
 dren — it is not simple enough. Their paps, panadoes, gruel, &c., are generally 
 enriched with sugar, spice, and sometimes a drop of wine; neither of which, they 
 ought ever to taste." We perfectly agree that neither spices, nor wine, should 
 enter into the composition of a child's food: but cannot consent, that sugar should 
 be omitted, since nature herself has largely furnished it in the mother's milk. — 
 And we have ever found this article not only a useful, but a desirable addition 
 to the food of a child. We sincerely believe that it does not happen once in a 
 million of times, that sugar is not acceptable to children of all ages. It is proper 
 it should be so, since it is highly nutritious. If sugar be improper, why does it 
 so largely enter into the composition of the early food of all animals? It is in 
 vain physicians declaim against this article, since it forms between seven and eight 
 per cent, of the mother's milk. 
 
02 OP FEEDING THE CHILD IN THE MONTH, &C 
 
 time, for it is much better to prepare fresh than to run the risk 
 of its becoming sour before it is used. 
 
 257. 5thly, The milk should never be heated by the fire ; this 
 should always be done, by adding the water hot, that is intend- 
 ed for its reduction ; or by a sand bath ; this will give it a suf- 
 ficient temperature, without incurring the liability to be over- 
 heated by being placed on the fire. 
 
 253. 6thly, In weather that is unfavourable for keeping milk, 
 it should be placed in the coolest place that can be commanded ; 
 or kept in often-changed cold water. 
 
 259. 7thly, Should the slightest tendency to acidity be ob- 
 served in the milk, it should be rejected without hesitation; nor 
 should an attempt be made at its supposed restoration, by using 
 an additional quantity of sugar, as this will eventually but in- 
 crease the evil. 
 
 260. We cannot declaim too loudly against the filthy, and of- 
 tentimes injurious practice of nurses, making every particle of 
 the child's victuals pass through their own mouths. The only 
 reason they can offer for this disgusting habit, is to prevent its 
 being given too warm — this, we grant, is a necessary and useful 
 precaution, but it can be easily arrived at, without the aid of 
 their lips, by adding hot water to the milk as just directed, in- 
 stead of placing it over the fire. On the same footing we would 
 place the blowing of it with their breath, to reduce its tempera- 
 ture. 
 
 261. Care should also be taken, that too much food be not 
 forced upon the child at once; it is much better it be fed often, 
 than it should receive too much at a time ; for the child when 
 it is fed, cannot exercise the discretion it is wont to do when it 
 sucks ; for when it has received enough by its own exertions, it 
 will stop spontaneously. 
 
OF OBSERVANCES TOWARDS THE MOTHER, &C 93 
 
 CHAPTER XV, 
 
 OF OBSERVANCES TOWARDS THE MOTHER DURING 
 THE MONTH, &c. 
 
 262. If the directions already given for the general conduct of 
 the woman during labour, and immediately afteF her delivery, 
 be strictly observed, it will rarely happen, that she will not have 
 what is called " a good getting up." This good getting up con- 
 sists in the gradual restoration of health, by a return of strength, 
 through the proper exercise of the functions of the stomach, and 
 the judicious employment of the various muscles of the body. 
 
 263. To ensure the healthy play of the stomach, and of the 
 muscular system in general, the patient should be managed in 
 such a manner, as will, in great probability, prevent tRe occur- 
 rence of disease, rather than be treated as if the evil were abso- 
 lutely present. For this purpose, frequent changes of linen, 
 and of every other solid article, is absolutely necessary, that there 
 may be no offensive gases generated, to contaminate the air of 
 the room, and render it unfit for the purposes of respiration. 
 
 264. Fresh air should, therefore, be freely admitted into the 
 room; but the woman should be placed so as not to receive a 
 partial current of it. Unfortunately for the interest of the pa- 
 tient, the nurse thinks for her on the subject, and effectually to 
 guard against the possibility of such an accident, she encloses her 
 in a space of six feet square, by curtains, and condemns her to 
 the horrors and mischiefs of breathing twenty times, the air that 
 has already been as often discharged from her lungs, and each 
 time loaded with an increased quantity of irrespirable gases. 
 
 265. One of the greatest improvements the lying-in room 
 ^could receive, would be, to banish curtains from the list of the 
 
 " indispensables," for furnishing it, or, at least, so to manage 
 them, as to make them subservient to ornament alone. The 
 pretexts for the employment of curtains are, first, " the bed looks 
 so naked without them ;" — this requires but a few fashionable 
 examples, to make it appear " when unadorned, adorned the 
 most ;" and it were a " consummation devoutly to be wished," 
 

 94 OF OBSERVANCES TOWARDS THE MOTHER 
 
 that some few of influence would lend their aid for this purpose, 
 for the benefit of their fellow-creatures. Secondly, " the danger 
 of catching cold;" — this is sheer cant; let every patient com- 
 mence without these articles, as many from necessity are obliged 
 to do, and they, like them, will have nothing to complain of, 
 that should be directly, or, with propriety, charged to the want 
 of curtains. If a room be so situated, as unavoidably to expose 
 the woman to a draught of air, a temporary screen will fulfil 
 every duty the curtains possibly can, without involving her in 
 any risk. Thirdly, "to protect the woman against too much 
 light." This reason is even more futile than the one last noticed; 
 for the inlets by which light is admitted can readily be shut, 
 without expense, or any very great exercise of genius. Fourthly, 
 and lastly, " Curtains in cold weather are necessary to keep the 
 patient warm." An additional blanket will do this vastly better. 
 
 266. Fresh air, we must repeat, is of the greatest possible ser- 
 vice to the lying-in woman; it is, in a word, indispensable to the 
 regular return of health; and, if properly indulged in, will pre- 
 pare the patient, without hazard, for the enjoyment of it abroad, 
 in suitable weather. It has been put to us as a question, " How 
 soon can a woman, after confinement, venture abroad safely?" 
 This question, like many others, would seem to require no con- 
 dition, and might be directly replied to; but it, like many others 
 of the same apparent simplicity, involves a number of considera- 
 tions, which are essential to be known, before it can be properly 
 and satisfactorily answered. 
 
 267. 1st, Because the period which may have elapsed after 
 delivery, cannot, of itself, be a guide ; for some women are bet- 
 ter at the end of five days, than others may be at as many 
 weeks; therefore, the actual condition of the woman must alone 
 be considered, and this without reference to the days that may* 
 have elapsed from the birth of her child. 
 
 268. 2dly, Because the season of the year, and state of the 
 weather will very much influence a decision of this kind ; for tj^ 
 weather may be such for weeks together, as to render it im- 
 proper for a delicate woman to leave the house ; as, in winter, 
 fall, or spring, or, even in summer, it might, for a short time, be 
 equally so from heat or rain. 
 
 269. Therefore, a conditional answer must always be given to 
 this question; and, we would say as a general rule, if, at the mid- 
 
DURING THE MONTH-, &C. 95 
 
 die, or end of the third week after confinement, the weather be 
 fine, and sufficiently warm to render much additional clothing un- 
 necessary ; and, if the patient be without disease, though, perhaps, 
 feeble, she may venture abroad in a close carriage, with much 
 advantage to herself and child. Robust women, when free from 
 any febrile affection, or local inflammation, may venture ever* 
 earlier. And, it may be well to recollect, that the sooner the 
 patient can safely take the fresh air, the better ; since both she 
 and the child will profit by its influence ; — for their is a vigour 
 and a healthy play given to, every function of the body, by air 
 and exercise, that cannot be procured by any other means. , 
 The best nurses are, therefore, those of active habits, and those 
 who can give employment to all the muscles of the body in the 
 open air: for, it will be obvious to every one, that, if the func- 
 tions of the body be not healthily performed, especially those of 
 the circulation, and the various secretions, the products of their 
 actions cannot be entirely healthy ; therefore, the milk by which 
 the child is to be sustained, may not be sufficiently nutritive, or 
 fail in other highly important qualities. 
 
 270. To a nurse, as well as to her child, there can be nothing 
 more prejudicial than an indulgence in habits too sedentary: the 
 exercise, therefore, we have recommended, should be enjoyed 
 whenever fit occasions may present themselves, that the milk 
 may be more certainly and abundantly secreted, and, at the same 
 time, its invigorating properties be increased; but, in indulging 
 in exercise, it is always to be understood that any excess of it 
 will be prejudicial. We would, therefore, wish to be considered 
 to mean only that degree of it which shall not to much hurry 
 and disturb the circulation, or occasion the woman to be over- 
 heated — consequently, running, too fast walking, or dancing? 
 should be carefully avoided; especially as much injury is done 
 the child, by its receiving the milk, after such violence has been 
 offered the circulatory system. 
 
 271. But should accident, necessity, or inattention, place the 
 B^tem in the situation just mentioned, the child must be with- 
 
 k held from the breast for at least two hours after the occurrence ; 
 and then the milk, which was present in the breast at that time, 
 must not be offered it — it must be drawn off by some other means, 
 and thrown away. The same may be said after an indulgence 
 in any violent passion, or emotion of the mind, as the most fright- 
 
96 OF THE DUTIES OF THE MOTHER * 
 
 ful and deadly consequences have followed a neglect of this pre- 
 caution. 
 
 272. It is said, by many, to be a good practice, " to gradually 
 accustom the woman to the air in the house, before she ventures 
 abroad ;" and too many adopt the plan, to the serious injury of 
 the patient. This is done, in cold weather, by making her tra- 
 vel up stairs* and down, in a strong current of air. The conse- 
 quences of such exposure may be easily imagined. 
 
 CHAPTER XVI. 
 
 t)F THE DUTIES OF THE MOTHER AFTER THE 
 MONTH, &c. 
 
 273. There is no solicitude more natural, nor more painful, 
 than that which a young and inexperienced mother feels, when, 
 for the first time, she is left to her own guidance in the manage- 
 ment of herself and child, by the departure of her nurse. For, 
 up to this moment, she looked to her for every direction, and for 
 the fulfilment of every necessary and important office, as well 
 for herself as for her child. But, left to her own discretion, she 
 feels, with more than necessary force, perhaps, the responsibility 
 of a mother — of a mother, on whose care and judgment the fu- 
 ture health and welfare of her child depend. She is willing 
 to suffer privations, or even to make sacrifices for its benefit, 
 but is ignorant when the one might be necessary, or where the - 
 other might be availing. Uncertain,, from want of experi- 
 ence, of the propriety of any thing she may do for either its 
 
 * There is a custom, among* nurses and gossips, no less absurd than ancient, 
 which obliges the woman to go " up stairs" before she ventures down; and this 
 is insisted on, be the season or weather what it may. By this plan, the woman 
 may be exposed to a cold and chilling atmosphere, immediately after leaving" -a 
 warm room, and, sometimes, perhaps, even when she is in a state of perspiration. 
 We have known a number of instances of severe "pull back," as they are called, 
 produced by a compliance with this superstitious and dangerous practice. The 
 good sense of every woman, who may become the object of this improper cus- 
 tom, should be exerted to destroy it, by not complying-' with it — and this, at the 
 risk of even offending " a nurse" 
 
 
AFTER THE MONTH, &C. 97 
 
 comfort, or its use, she trembles, lest she commit an error ; nor 
 is she confirmed in her own opinion, until she has the cold and 
 negative proof, that what she has done has not done harm. Or 
 she may, from loo great an indulgence of her fears, neglect the 
 most common and obvious of her duties, 
 
 274. The delightful task, to the inexperienced mother, of wash- 
 ing and dressing her infant, is to her a source of inexpressible 
 anxiety. She applies water to its body with a sparing and trem- 
 bling hand ; the child, perhaps, cries upon ils application ; the 
 over-sensitive mother becomes alarmed, lest she has given it un- 
 necessary pain, or has done something improper; she becomes 
 agitated, and but partially washes, and but imperfectly dries it; 
 or she abandons the operation to one of less feeling, but, perhaps, 
 of no more experience than herself, and this, perhaps, to the in- 
 jury of the child. 
 
 275. We once witnessed a most interesting scene between a 
 young mother and her husband, upon an occasion similar to the 
 one of which we are now speaking. We were chatting with the 
 young lady in a lively manner, when her husband suddenly en- 
 tered the room — she sprang upon her feet, and violently clasped 
 him round the neck, and with a convulsive cry of exquisite plea- 
 sure, she sobbed out, "I dressed our Julia to-day, entirely with 
 my own hands !" And never did we see a finer subject for a 
 skilful painter, than the one presented by this interesting couple, 
 at this moment. We soon learned that the performance of this 
 duty had, up to that moment, been one of great misery to the 
 too timid mother. 
 
 276. We would earnestly recommend to every mother with 
 her first child, to try her skill daily at washing and dressing her 
 infant, a week or ten days before her nurse leaves her, that she 
 may become familiar with the routine, and gain a little experi- 
 ence in the method. Indeed this cannot be too seriously recom- 
 mended ; the mere handling of the child requires, to do it in the 
 best manner, some experience; a mother may learn much as re- 
 spects this from a handy, and experienced nurse, and will be am- 
 ply repaid for looking on during the operation. 
 
 277. The next anxiety which a young mother feels, is upon 
 the subject of what is most proper for her to eat and drink, il as 
 a nurse." For this information, she appeals to those whose greater 
 experience, she supposes, would well qualify them to answer. 
 By one, certain articles of diet arc recommended as indispensa- 
 
 13 
 
98 OF THE DUTIES OF THE MOTHER 
 
 ble; by another, they are condemned as improper,if not as po- 
 sitively injurious. Other substances are extolled in their turn ; 
 but, unfortunately, these are forbidden by other advisers, and 
 that with an earnestness that bids defiance to either argument or 
 resistance. Perplexed by such discrepancies, she knows not 
 what plan to pursue ; and when she has become almost a prey 
 to anxiety, some sensible friend lays down a rule, which, as a 
 general one, is the only one that should have been given at first; 
 namely, to eat and drink such articles of diet as her former expe- 
 rience had proved did not disagree with her own stomach, and 
 to pursue this plan, unless a farther experience should declare 
 it to be improper, or injurious to herself or her child. 
 
 2^8. No advice, perhaps, can be more safe and judicious than 
 this ; for we have almost uniformly observed, that whatever food 
 is found to agree with the mother, is almost sure to do so with 
 the child ; therefore, such substances as are said to disturb the 
 latter, will almost always be such as have disagreed with the mo- 
 ther previously. Nor is this of difficult explanation. Any sub- 
 stance, with which the stomach is not familiar, or to which it is 
 not entirely reconciled, will be either rejected altogether, or will 
 be but incompletely digested. If it be but imperfectly assimi- 
 lated, it will enter the system as ill-elaborate chyle ; and this, 
 necessarily, will make a corresponding change in the quality of 
 the milk. In this state it is received by the child ; its stomach 
 not being able to subdue it to a proper nourishment, flatulency 
 i£ produced, or, perhaps, even vomiting, ensues. 
 
 279. Certain liquors, as ale, porter, beer, &c; certain sub- 
 stances, as cabbage, sweet potato, pickles, vinegar, &c, are all, 
 in their turn, said to disagree with the child — that is, as we 
 would insist, they disagree with the mother ; they should, there- 
 fore, be abandoned, without hesitation, for her own sake — for 
 there the mischief begins ; but there it will not stop, unless she 
 have sufficient resolution to give them up ; for her child will soon 
 feel the effects of such irresolution ; and how.extensive these may 
 become, it is impossible to say. • 
 
 280. Serious mischief is oftentimes done by the mother at- 
 tempting to remedy every temporary diminution of milk, by in- 
 creasing the quantity of her food, or by imagining that some sti- 
 mulating drink will answer this valuable end. Hence, indiges- 
 tion, fever, and sometimes a habit is generated of too freely in- 
 dulging in ardent spirit. This practice has, for its excuse, that 
 
AFTER THE MONTH, &C. 99 
 
 the milk fails, because the woman is weak, owing to her not 
 taking a sufficiency of nourishment; hence, too much feeding is 
 indulged in, to remedy this supposed weakness — a task is now 
 imposed upon the stomach that it cannot perform, however 
 healthy it may be, and indigestion must, of course, sooner or 
 later, be the consequence. Or, owing to some trifling disturbance 
 in the system of a temporary kind, the secretion 6( milk may be 
 for the moment suspended, or diminished : an attempt is made to 
 recall it by an increase of food, by which a slight inconvenience 
 is converted into a permanent derangement of the system ; or a 
 fever of even a dangerous character, may be generated. Or, 
 owing to a false theory, or imperfect observation, it has been 
 supposed that certain liquors have a control over the secretion 
 of milk ; and hence, the too free use of certain combinations, in 
 which ardent, or fermented spirits, too largely enter : thus, por- 
 ter, ale, milk punch, &c, become the ordinary beverage of nurses, 
 to the almost certain destruction of their morals. 
 
 281. We must not, however, be supposed to deny the influ- 
 ence of certain solid, as well as fluid substances, upon the secre- 
 tion of milk ; this would be turning our eyes from reason, as well 
 as experience ; for we well know, that unless the body be pro- 
 perly supported, there must soon be a diminution of milk. We 
 only mean to insist, that it is the nutritious, and not the stimu- 
 lating part of diet, that is subservient to the plentiful, and health- 
 ful formation of this fluid. In proof of this, we need only observe, 
 that we have often been consulted upon the subject of the failure 
 of milk, where an anxious mother herself, or a hireling nurse 
 was concerned, and been informed by them, that they had tried 
 every thing with a hope of improving it ; such as rich victuals, 
 porter, ale, beer, milk punch, &c., without success, or it was 
 followed, perhaps, by a diminution of it. 
 
 282. In such cases, we have often succeeded in producing a 
 plentiful supply of milk, by adopting the opposite plan of treat- 
 ment; for it must be borne in mind, as an important truth, that 
 this failure proceeds more frequently from an over, than from an 
 under quantity,, of food, or of drink. It is a fact, well known to 
 all who have paid attention to the consequences of arterial ex- 
 citement, that when it amounts to even moderate fever, the milk 
 almost immediately diminishes in quantity; and, also, when this 
 action is diminished, (provided it had not continued too long, 
 
100 OF THE DUTIES OF THE MOTHER 
 
 by suitable remedies, that the secretion of milk again becomes 
 more abundant. 
 
 283. Upon this principle, we have frequently prescribed eva- 
 cuants, and abstinence, to promote the secretion of milk. With 
 a view to illustrate this situation of the breasts, under an increased 
 excitement of the system; and the advantage, nay, the absolute 
 necessity of reducing the force of the blood vessels, for the pur- 
 pose of restoring their secretory functions, we will relate one, of 
 several cases, in which this plan was pursued. 
 
 284. Mrs., informed us, with great concern, that she 
 
 would be under the necessity of procuring another wet nurse for 
 her child, as the milk of the one she had diminished so rapidly, 
 as to make her certain her child could not be half nourished. It 
 had begun to fail about three weeks before, without any evident 
 cause; and although she had constantly tried the most generous 
 diet and cordial drinks she could hear of, still it diminished 
 daily, and wag now so reduced, as to scarcely offer enough for 
 the child, once in twenty-four hours ; or, rather, the whole quan- 
 tity furnished in that period, would not amount to more than one 
 good meal. 
 
 285. We requested to see the nurse ; she was, accordingly, 
 presented. She was a young, healthy-looking woman of florid 
 complexion, and clear skin, and without a single mark, that 
 would lead to the suspicion of a deficiency of milk from any im- 
 perfection of constitution-^-her milk was six months old, as it is 
 called ; she had been engaged in this family about three, of that 
 time. She was from the country, and for some time gave en- 
 tire satisfaction, as to her conduct, temper, health, and quantity of 
 milk. Upon being questioned, we found she was living upon a 
 much more generous and stimulating diet, than she had been pre- 
 viously accustomed to — she not only ate more at each meal than 
 she had formerly done, but ate a greater number of meals; and, 
 instead of drinking milk, water, or milk and water, as she was 
 wont to do before at such times, she was indulged in porter, ale, 
 beer, milk punch, &c, with a view of keeping up her milk. 
 
 286. We found she had occasional headach; rested ill at 
 night; had a disagreeable taste in her mouth in the morning; her 
 tongue was furred, and her pulse full and frequent. It was evi- 
 dent her system was too much excited by her mode of life, and 
 that nothing would restore her milk but a reduction of diet. We 
 
AFTER THE MONTH, &C 101 
 
 accordingly, ordered her to be bled; to take a brisk dose of salts; 
 confine herself to a strict vegetable and milk diet, and to drink 
 nothing but water. 
 
 287. At first, we experienced much opposition to this plan; 
 but it was eventually submitted to, and with such complete and 
 rapid success, that in a week there was a sufficient secretion of 
 milk. It may be proper to observe, that this woman, after this 
 period, confined herself to a plain, simple diet, and never after 
 had occasion to complain of a deficiency of milk. 
 
 288. This case, among many others, shows us, that the scheme 
 the wealthy and plentiful families adopt with their wet nurses, 
 is wrong from beginning to end. As little change should be made 
 in the diet of the nurse as is strictly consistent with sufficient 
 nourishment, and none, perhaps, in her habits of employment ; 
 that is, she should not exchange active for passive habits. If she 
 have been accustomed to work, give her, by all means, uniform 
 employment. If she have been much exposed to the air and 
 weather, let her and the child have the advantage of air and 
 exercise, upon all proper occasions. The extremes of heat and 
 cold should, of course, be avoided, as well as a wet atmosphere. 
 
 289. This case, also, well illustrates the position we have en- 
 deavoured to sustain ; namely, that a stimulating diet is not the 
 best method to procure an increase of milk. But, at the same 
 time, we are far from declaring, that a more generous diet may 
 not be occasionally necessary — but such cases are by no means 
 so common as is generally imagined, and still more rarely is a 
 stimulating one proper. 
 
 290. The remedies which we have ever found to contribute 
 most to the improvement of the milk, are, regular exercise in the 
 open air, milk and water, milk alone, malt tea,* molasses posset,f 
 or porter, or ale posset,J when a mild stimulant may be required. 
 
 * Malt tea is made by pouring- a quart of boiling water upon a gill and a half 
 of ground malt, which is permitted to stand, after two or three good stirrings 
 with a spoon, until cold: it must then be strained off. The tea may be sweet- 
 ened, or no^; or, it may have the addition of milk. 
 
 f Molasses posset is made by throwing a wine-glassful of molasses into a quart 
 of milk, after the latter has been heated nearly to the boiling point; it is then per- 
 mitted to cool — the whey to be poured off and drunk. 
 
 t Porter or ale posset is made precisely as directed for the molasses posset, ex- 
 cept that half a pint of either of these liquors is substituted for the molasses, and 
 it is permitted to stand until a separation takes place. 
 
 Dr. Struve says, (Phys. Ed. p. 225,) "There are certain means by which the 
 
102 RECAPITULATION. 
 
 These may be drunk freely, at any period of the day or night; 
 and the nurse who may employ them, will find herself much sa- 
 tisfied with their effects. 
 
 291. Having in the foregoing pages, considered what may be 
 proper for the woman during the periods of gestation, labour, 
 and during the period of confinement; also, what may be deemed 
 important to the child after its birth to the end of the month, it 
 may be farther useful to bring the whole of our instructions upon 
 these points into a condensed form ; we shall, therefore, sum up 
 the various directions we have given, divested of the arguments 
 by which they were sustained, in the form of a " Recapitula- 
 tion." By this means, the reader can in a moment become pos- 
 sessed of the instructions, without going through, a second time, 
 the reasonings. This plan will contribute to aid the memory 
 much, since the directions are numerous, and, perhaps, in some 
 instances, novel ; and may require repetition, to fix them suffi- 
 ciently well upon the recollection of those who may wish to abide 
 by them, themselves, or merely to inform themselves of what can 
 be said upon this interesting and highly important subject. 
 
 CHAPTER XVII. 
 
 RECAPITULATION OF THE INSTRUCTIONS GIVEN TO 
 THE FEMALE DURING PREGNANCY, LABOUR, AND 
 CONFINEMENT ; AS WELL AS RULES FOR THE GE- 
 NERAL MANAGEMENT OF THE CHILD DURING THE 
 MONTH* 
 
 292. To prevent abortion, &c, she should scrupulously ob- 
 serve the following rules: — 
 
 293. 1. She must avoid all unnecessary and, especially, vio- 
 
 milk of a suckling woman may be increased or dilated. In the first place, I 
 would advise her to drink a glass of cold water every morning, but to adopt no 
 remedies, however specially recommended by common midwives." He then 
 recommends the porter posset suggested above. 
 
 * We have not thought it necessary to make a summary of the chapter upon 
 " Marriage." 
 
RECAPITULATION. 103 
 
 lent exercise, or exertion ; such as too fast walking, running, 
 dancing, &c. 
 
 294. 2. To avoid, as much as may be, placing herself in a si- 
 tuation which may subject her to unpleasant sights or seeming 
 dangers* 
 
 295. 3. To shun over-heated rooms, and stimulating liquors 
 of every kind. 
 
 296. 4. To avoid all substances that have a tendency to pro- 
 duce a costive state of bowels ; or those which may give rise to 
 " indigestion," as late suppers, too great n quantity of food, &c. 
 &c. 
 
 297. 5. To take no substance, or drug, that shall give too fre- 
 quent, and too severe motion to the bowels ; or such as shall too 
 severely constipate them, as chalk, opium, &c. ; and, especially, 
 not to disregard the calls of nature, when they would be success- 
 fully exerted. 
 
 298. 6. To remove from her chest, waist and abdomen every 
 restraint ; lest undue pressure should be made upon them, 
 
 299. 7. To avoid all substances that may have a tendency to 
 increase the irritability of the system ; as strong tea, coffee, 
 opium, &c, the too long indulgence in bed, &c. 
 
 300. 8. To shun all severe study, night watching, &c. 
 
 301. 9. To avoid, with much care, unnecessary blood-letting, 
 or submitting to this operation, merely because she is pregnant. 
 
 302. 10. To have, however, recourse to this operation, when 
 pain, headach, a sense of fullness, giddiness, the loss of, or im- 
 perfect sight, &c, may be present to declare the necessity of it 
 — but it were always better, when practicable, to have the ad- 
 vice of a physician. 
 
 303. 11. The woman who may be in the habit of miscarry- 
 ing ? should never venture upon blood-letting without advice, as 
 it sometimes produces the evils it is intended to prevent. 
 
 304. 12. To avoid the indulgence of all inordinate appetites; 
 as too much repletion of the stomach may give rise to many for- 
 midable diseases. 
 
 305. 13. She must give up the false notion, that more food, 
 &c, than ordinary, is required because she is pregnant, as the 
 opinion is not founded in either reason or experience. 
 
 306. 14. She must assure herself, by a reliance upon the 
 opinions of those whose business it is to ascertain the truth upon 
 
104 RECAPITULATION. 
 
 this point, that nature institutes the sensation of nausea, and the 
 act of vomiting, with a view to prevent too great fulness, during 
 this period. 
 
 307. 15. She must not indulge in the fear, that should a cer- 
 tain longing have been ungratified, her child incurs the risk of 
 being marked in consequence of the disappointment, as this ap- 
 prehension is not warranted by reason, nor confirmed by expe- 
 rience. 
 
 308. 16. She must dismiss from her mind, all apprehension of 
 future consequences to her child, should she have been so un- 
 fortunate as to have suffered any great alarm ; been surprised 
 by any unexpected event, or appalled by some frightful object 
 or occurrence — as there is no one good reason to believe in such 
 influence upon the child. 
 
 309. 17. To most sedulously guard against any .sudden gusts 
 of passion; as any indulgence in them, may be highly injurious, 
 if not fatal to herself and child. 
 
 310. 18. To solicit, as much as possible, tranquillity, and 
 equanimity; as their influence is highly valuable to herself and 
 child. 
 
 311. 19. To believe, in general, that food injures more by its 
 excess, than its quality ; by taxing the powers of the stomach 
 too highly. 
 
 312. 20. To avoid, with as much care as she would impend- 
 ing ruin, an indulgence in cordials, liquors, &c, under the pre- 
 texts of calming sickness, relieving pain, or expelling wind ; as 
 a destructive habit is but too easily generated by their employ- 
 ment. 
 
 - 313. 21. She must not persuade herself, it is only the exces- 
 sive indulgence in such articles, that is mischievous; but she 
 must clearly understand, that every thing which may unduly 
 stimulate the system, is highly injurious to the pregnant woman. 
 
 314. 22. Let her turn a deaf ear, to every tale of disaster, or 
 of horror, which purports to have happened to the pregnant, or 
 lying-in woman ; for, upon investigation, such tales will almost 
 always be found without foundation, or very greatly exagge- 
 rated. 
 
 315. 23. Let her procure the best aid, for the period of her 
 necessities, that circumstances will permit. 
 
 316. 24. Let her not be imposed upon by a false theory, or 
 
RECAPITULATION. 105 
 
 bad advice; nor use too much exercise towards the latter period 
 of her time, lest she provoke premature labour. 
 
 317. 25. Let her not, when the period of labour is approach- 
 ing, indulge in gloomy forebodings, or in unreasonable fears for 
 the event ; nor, by any means whatever, forget, how rarely death 
 happens during, or even after, a well-conducted labour. 
 
 318. 26. Let her not attempt to increase the frequency, or 
 force of her pains, by taking improper articles of food, or by fre- 
 quent marchings across the floor. 
 
 319. 27. Let every precaution be taken against an attack of 
 fever; for this purpose, she must scrupulously avoid every sti- 
 mulating substance, either as food, drink, or remedy. Let her 
 bear in mind, that an overcharged stomach is always unfavoura- 
 ble to the healthy progress of labour, or its eventual safety. 
 
 320. 28. To prevent despondency, because the labour may 
 be rather longer than she anticipated ; let her recollect, that 
 the safety of this process does not depend upon the celerity with 
 which it is performed. 
 
 321. 29. That she may secure to herself the best possible 
 chance for her safety, let her have no opinion of her own, that 
 may clash with those of her medical attendant; let her, there- 
 fore, be passive, and obedient. 
 
 322. 30. Let her not, as she values her life, indulge in any 
 gust of passion ; lest she provoke incurable convulsions. 
 
 323. 31. Immediately after she is a mother, she must impose 
 upon herself the most perfect tranquillity ; that no untoward cir- 
 cumstance may be provoked. 
 
 324. 32. She must carefully avoid all the exciting causes of 
 fever, as far as in her power, by not indulging in improper arti- 
 cles of diet ; sitting up too early, and too long ; too hot a room ; 
 curtains loo much closed ; or seeing too much company. 
 
 325. 33. She must aid the exertions of her physician, to pre- 
 vent any after evil;, by implicitly following his directions, and 
 preventing, as much as may be in her power, the nurse running 
 counter to them, especially until after the fifth day complete. 
 
 326. 34. Let her not permit herself to be persuaded from 
 having her child put to the breast ; as soon as she herself may 
 be able to bear the fatigue. 
 
 327. 35. Let her not delegate to another, the sacred duty of 
 
 14 
 
106 RECAPITULATION. 
 
 nursing her own child ; unless the reasons for so doing be insur- 
 mountable. 
 
 328. 36. She must most scrupulously attend to the dressing 
 and undressing, or even performing this herself, when her health 
 and strength will permit this delightful task. 
 
 329. 37. She should never, under any pretext of convenience, 
 permit her child to be fed, so long as she can supply it with suf- 
 ficient nourishment herself: and to secure to herself this impor- 
 tant point, she should pay a scrupulous regard to her diet, and 
 her exercise in the open air. 
 
 330. 38. The dressing of the child should early engage the 
 attention of the mother ; it should always be made subservient 
 to comfort, instead of show. 
 
 331. 39. This should consist in part of flannel; especially 
 during cold or even cool weather. 
 
 332. 40. The dressings of the child should be changed as of- 
 ten as they become soiled ; when this luxury can be indulged in. 
 
 333. 41. Though it may be found, that flannel is the most eli- 
 gible substance, as a general rule, there are cases in which it 
 may be improper ; and these should be. carefully distinguished. 
 
 334. 42. The belly band is one of the most important parts 
 of the child's dress ; it should always be made of flannel, and 
 should be always cut bias. 
 
 335. 43. The greatest care should be taken to apply it pro- 
 perly ; but too tight an application should be particularly 
 avoided. 
 
 336. 44. If this bandage be applied too tightly, it may produce 
 the evil it is intended to prevent. 
 
 337. 45. The child should be carefully protected against all 
 unnecessary wet ; and when it is discovered to be in this situa- 
 tion, it should be changed as quickly as possible. 
 
 338. 46. In dressing the child, as few pins should be employed 
 as possible ; three are all that are necessary, if the clothes be 
 properly arranged. 
 
 339. 47. As a general rule, the child should never be fed, at 
 this period of its life ; there may be exceptions, however, that 
 may render this necessary. 
 
 340. 48. When an exception to this rule exists, the food of 
 the child should consist of milk, water, and sugar; and exhibited 
 under the important restrictions we have made. 
 
RECAPITULATION. 107 
 
 341. 49. If the child be fed, it should have but small quanti- 
 ties at a time, and never crammed to surfeit. 
 
 342. 50. The woman should exercise in the open air, as soon 
 as this is rendered safe, by the state of her health, the period af- 
 ter confinement, and the state of the weather. 
 
 343. 51. She should never subject herself to partial expo- 
 sures, under the hope of " hardening herself." 
 
 344. 52. The reapplication of a diaper after it has been dried 
 simply, should be prohibited; as several evils arise from the 
 practice. 
 
 345. 53. The mother may indulge in such diet, as her expe- 
 rience has proved to be innocent — for it will seldom or never 
 disagree with the child, when it perfectly suits the mother. 
 
 346. 54. When the mother experiences any inconvenience 
 from the use of any substance or substances, she should not he- 
 sitate a moment to abandon them ; for if they disagree with her, 
 they will be sure to do so with the child. 
 
 347. 55. Should there be a failure in the quantity of milk, 
 the mother must nt>t attempt to increase it, by highly seasoned 
 food and stimulating drinks. 
 
 348. 56. She may sometimes, however, use with great advan- 
 tage, the nutritious substances recommended in the text. 
 
 349. Having, in the preceding pages, considered the duties of 
 the mother during pregnancy, and confinement; we shall now 
 proceed to detail what may be proper for the offspring, from the 
 period of its birth to that of puberty. We shall confine our- 
 selves, in this part of our subject, strictly to the physical influ- 
 ence of certain agents upon the human body ; and the most pro- 
 per physical education, up to the period just prescribed. The 
 medical treatment will form a distinct subject of consideration, 
 and the moral we do not propose to treat of. But, before w T e 
 commence this part of our subject, it will be well to describe 
 the requisites of a nursery. 
 
108 Of THE NURSERY. 
 
 CHAPTER XVIII. 
 
 OF THE NURSERY, 
 
 350. Every body, almost, in easy circumstances, has a part 
 of the house appropriated to what is called the " Nursery." 
 The one chosen for this important purpose, is, generally* or at 
 least too often, the most exceptionable part of the building. It 
 is usually selected because it is '* handy," or .because it is the 
 only one that can be spared ; without the smallest attention be- 
 ing paid to its fitness for the purpose for which its designed. 
 
 351. The room for the purposes of a nursery, should have 
 every advantage which space or location can give, when either 
 or both can be commanded. We shall, therefore, say in what 
 a well appointed nursery should consist, leaving it, of course, to 
 the ability of every individual to adopt or approach it, as nearly 
 as circumstances may permit. 
 
 352. The nursery should be spacious, with a high ceiling, 
 and perfectly dry ; it should not be exposed to the operation of 
 any cause that may render it damp; as, on a ground-floor; too 
 much shaded by trees ; or placed beyond the occasional influ- 
 ence of the sun. Its windows should be tight, and the walls 
 dry ; the floor should be of wood that will quickly dry after be- 
 ing wetted for the purposes of cleanliness; but the utmost care 
 should be taken, not to hasten this process, by placing ignited 
 charcoal in its centre. Serious mischief has frequently arisen, 
 by this absurd and dangerous practice. 
 
 353. It should be so situated, that the door or doors shall not 
 ©pen immediately on staircases; or, should this be unavoidable, 
 the heads of the stairs should be secured by latticed half-doors, 
 and these so constructed, by having their slats placed perpendi- 
 cularly, that the child cannot climb upon them, and thus defeat 
 their object 
 
 354. The windows should have cross-bars placed before them, 
 to remove apprehension of accident to the child. They should 
 be five inches distant from each other, that the windows may be 
 opened for the purposes of ventilation or air. They should have 
 shutters, that the room may be darkened, when the abstraction 
 
OF THE NURSERY. 109 
 
 of light becomes necessary. The windows should not have cur- 
 tains of a glaring colour, as the light will be increased thereby, 
 and prove injurious to the eyes of young children. 
 
 355. If possible, the nursery should consist of two rooms; and 
 if they opened into each other, it would yield very great advan- 
 tages ; the children could retire to one, while the other was ven- 
 tilating, or getting cleaned, by washing or sweeping ; this would 
 contribute greatly to their comfort, as well as to their health. 
 They would, also, be removed from the dangers of damp, the in- 
 convenience of dust, the risks from a cold stream of air, while 
 the room is drying or sweeping, besides having an enlarged 
 space for the exercise of their limbs. In a space so extensive as 
 this, they could improve their strength by engaging in many 
 little sports, which children are so ingenious in devising, when 
 they cannot from the condition of the weather, take exercise in 
 the open air. 
 
 356. Besides, such an arrangement will permit the children 
 to have a room, fresh and sweet, in the morning, after having 
 rendered the other foul by sleeping in it. This is an advantage 
 which has been but too little attended to, notwithstanding its ob- 
 vious utility ; especially to the younger children, who cannot al- 
 ways escape into the purer air of other parts of the house. 
 
 357. Carpets, in cold weather, are decidedly useful, if they be 
 properly managed ; that is, well shook, and aired, every week. 
 By this means, the dust is removed from them, and they have 
 the advantage of becoming dry by exposure. We are sensible 
 that several objections may be raised against carpeting a nurse- 
 ry; as the great quantity of dust they acumulate ; their becoming 
 often wet, without the chance of drying ; their retaining grease 
 so fixedly as not to be removed; their absorbing, and then giving 
 out a variety of impurities, &c. But, notwithstanding all these 
 reasonable objections, we are persuaded, that one single advan- 
 tage which they possess in a nursery, overbalances all that may 
 be said against them — namely, their protecting the heads and 
 limbs of children from injury when they fall. 
 
 358. The elastic material (wool) of which the carpet is formed, 
 is well calculated to break the force of the blow which the head 
 or limbs of the child receive, when it falls upon it ; so much so 
 is this the case, that we have not known a single instance of se- 
 rious injury from falls upon them. We are sure to have our 
 
110 OF THE NURSERY. 
 
 anxiety diminished, when called to a child who has received a 
 blow upon the head from a fall, when we are informed, it fell 
 upon a carpet. We are, therefore, of opinion, that, when the 
 child falls from a moderate height, it will rarely, if ever, suffer a 
 serious injury from it — this, certainly, would not be the case did 
 the child fall upon the naked floor. * 
 
 359. We must, however, be understood to recommend car- 
 pets in cold weather only ; for, as soon as the weather becomes 
 sufficiently warm to do without fire, the carpet should be re- 
 moved, and its place supplied by an even, well-stretched mat; 
 or the floor may even be left bare ; for, at this period it is to be 
 presumed, children will be but little confined to the nursery, 
 unless the state of the weather prohibit their enjoying the open 
 air : this state of the weather may consist in its being wet, too 
 windy, or too hot. 
 
 360. The furniture of a nursery should be as little in quantity 
 as convenience will permit, that the children may have the space 
 that would be necessarily occupied by many articles; especi- 
 ally chairs and tables. It should, therefore, consist of the beds 
 for the children and nurse, or we would rather say mattresses, 
 as we are of opinion that feather beds should be driven from the 
 nursery, for the following reasons — first, they are too warm for 
 the purposes of the best health, especially w 7 ith feeble children ; 
 accumulating so much heat, as to unduly stimulate the whole 
 cuticular system ; thus giving rise to unnecessary, nay, injurious 
 perspiration ; secondly, the effluvium from feathers is extremely 
 oppressive, particularly in warm weather, and to children of 
 feeble lungs; thirdly, they discharge a prodigious quantity of 
 dust, intermixed with minute portions of down, occasioning cough, 
 and other inconveniences. 
 
 361. If it be objected, that mattresses are too cold in our cli- 
 mate for winter, we would immediately obviate it, by recom- 
 mending the spreading of a blanket over the mattress, which will 
 effectually remove the inconvenience complained of. 
 
 362. When practicable, children should sleep in separate beds; 
 and these should be large; for it is injurious to have them cramped 
 when they sleep, as well as indelicate to crowd opposite sexes to- 
 gether. Besides, the degree of heat generated by contact, will 
 be certain to make them uncomfortable; they will throw off the 
 bed-clothes, and thus expose each other to colds. 
 
OF THE NURSERY. Ill 
 
 363. Children should never have more bed-clothes spread over 
 them than is sufficient to maintain a proper degree of warmth : 
 if more be put upon them, they become oppressed, or perspire ; 
 both of which should be avoided : or they become too warm, and 
 throw the bed-clothes off them, and thus when the skin is pouring 
 out perspiration, the discharge is suddenly checked, to the mani- 
 fest injury of the child. We have often known whole nights 
 spent without covering; for if. children become cold, from re- 
 moving the clothes, they are very rarely sensible of it ; they sleep 
 too soundly, for the most part, to restore the covering again. 
 
 364. Should we not, however, succeed in establishing our ob- 
 jections against feather beds in winter, we are persuaded every 
 body will agree in the use of mattresses during hot weather. 
 Should these not be at command, the sacking-bottom, or even 
 the floor should be substituted— for almost any thing is prefe- 
 rable to feathers. 
 
 365. It is in the nursery, in a great measure, that the habit 
 of early or late rising is generated — this is a matter of much 
 importance; and the greatest regularity should be observed, that 
 a proper one be formed. Children should, therefore, retire at a 
 regular, and sufficiently early hour, to ensure their early getting, 
 up ; for beyond a certain time sleep is injurious. It would, 
 however, be a little difficult to establish a positive rule upon 
 this subject, as some children, like adults, will require more 
 sleep than others. Children who exercise much, will need 
 more sleep than those who exercise but little ; consequently, 
 they should not be confined to precisely the same number of 
 hours. 
 
 366. All children are disposed to be early risers ; this propen- 
 sity should, therefore, be cultivated, by permitting them to re- 
 tire sufficiently early to bed; and after they are in bed, they 
 should not be allowed to keep each other awake by playing, and 
 thus depriving themselves of sleep; for the same reason, no 
 noisy employment should be permitted in the nursery, that the 
 children need not be disturbed. Indeed', it would be best, when 
 children have attained their third year, or even before, that they 
 should not be allowed even light in their rooms, that they need 
 not unnecesarily be kept from sleep, as well as to prevent any 
 apprehension from being left in the dark. 
 
 367. When children first awake in the morning, however 
 early this may be, provided it be day-light, they should be al- 
 
112 OF THE NURSERY. 
 
 lowed to get up, and be dressed ; for if this be not done, and 
 they are forced to lie longer than is pleasant to themselves, they 
 will become fretful and dissatisfied, or again fall to sleep — in ei- 
 ther case, a real evil is induced: in the first, the disposition of the 
 child is injured ; and, in the second, a habit of lying too long is 
 generated. 
 
 368. It should be carefully guarded against, that no unneces- 
 sary habits are indulged in during the period set aside for sleep; 
 such as drinking water several times in the night, or rising too 
 often to discharge the contents of the'bladder. If the first be in- 
 dulged in, an artificial thirst will be created; if the second, the 
 bladder acquires a preternatural degree of irritability, which is 
 almost sure to terminate in the disgusting and inconvenient habit 
 of wetting the bed. 
 
 369. After children have risen from their beds, they should 
 be dressed as quickly as possible; they should be carefully 
 washed and combed, and then be permitted to inhale the fresh 
 air, either in doors or without, with as much freedom as the na- 
 ture of things will permit. For the first purpose, the nursery 
 should be well, but carefully ventilated ; or, what is still better, 
 the children should be allowed to retire to another room, when 
 practicable, and, especially, during the time the nursery is clean- 
 ing; hence, the propriety of two rooms being devoted to this 
 purpose; and, for the second, when the weather is proper, they 
 may be allowed to go out of doors. 
 
 370. So soon as the above necessary operations are performed, 
 children should have their breakfasts; so that the stomach need 
 not suffer, either from too long fasting, or from the indulgence 
 of too great an appetite, excited by long abstinence. 
 
 371. A cradle for young children is a very important appen- 
 dage to a nursery, notwithstanding the objections which have 
 been made against it, by ingenious speculators upon the subject 
 of the physical education of children. The advantages of the 
 cradle are, 1st, it can be placed in any situation of the room, 
 without disturbing the child, for the advantage of either warmth 
 or coolness ; for light or darkness, or for air ; 2dly, it supplies the 
 most gentle and certain anodyne, if we may so term it; since it 
 will amuse by its motion, when the child is placed in it awake ; 
 lull by its sameness, when disposed for sleep; and perpetuate it, 
 when desirable, by a familiarity with its action ; for it must be 
 recollected, that, for nine months previously to birth, the child 
 
OF THE NURSERY. 113 
 
 has been indulged in the gentlest motion, in the fluid in which it 
 constantly swims, consequently, the motion of a cradle would 
 seem to be but a continuation of an exercise, to which it had 
 been long used. 
 
 372. The objections to the use of the cradle are easily obvi- 
 ated. It is said, it may produce fatuity, by constantly shaking 
 the brain ; this could not possibly happen, unless the cradle were 
 violently agitated ; in which case, it would be the abuse of the 
 cradle that should be objected to ; since no such consequence can 
 possibly follow its proper use: for, did gentle agitation do mis- 
 chief to the organization or functions of the brain, why are not 
 all children born fatuitous, since that organ is subjected to it 
 from its earliest formation 1 Another objection is urged, which 
 is as easily. obviated: it is said, the child runs much risk by its 
 liability to overset — now, it must be by the employment of ex- 
 treme violence, or carelessness, that this can be looked upon as 
 an objection to the cradle; for, certain it is, that a proper use of 
 this machine can never be attended by such a consequence. 
 
 373. In using the cradle, however, 'we would suggest certain 
 precautions, that it may not be converted into an improper ma- 
 chine. We would forbid all violent motions of it, since it would 
 not only defeat the objects for which it is employed, but might 
 be attended with the risk of oversetting. The motion of the 
 cradle should be made an efficient means to procure rest; and 
 should, therefore, not be so constantly used as to lose its effects, 
 by too frequently employing it ; nor should its influence ever be 
 taken advantage of, to procure more than the necessary degree 
 of sleep, as it may tend to the disadvantage of the child ; nor 
 should we think the cradle necessary to children much beyond 
 the second year, as, at this time, their exercise will dispose them 
 to sleep soundly, without its agency. 
 
 374. The means by which the nursery is warmed, is not a 
 matter of indifference. Two important objects should always 
 be kept in view, in constructing it — namely : first, security from 
 accident to the children ; and, secondly, affording 'sufficient 
 warmth. 
 
 375. These may be secured, by an open fire of wood, or of 
 coal, protected by a high and substantial fender of wire, that the 
 children may not approach it too nearly ; or by a stove placed 
 near the hearth, and defended by an iron railing. We, how- 
 ever, should never advise the stove, where an open fire can be 
 
 15 
 
114 OF THE NURSERY. 
 
 made use of with equal advantage as regards heat; and we be- 
 lieve that the introduction of the Lehigh coal will secure to us 
 this desirable end, with less expense and more security than any- 
 other method. 
 
 / 376. The objections to a stove are numerous, and deserve a 
 serious attention — 1st, there is great danger that the children 
 may get severely burned, as we have often witnessed ; 2dly, they 
 are almost always too much heated ; 3dly, the air is rendered 
 too dry, by a destruction of its moisture, and becomes impure 
 by the burning of millions of little particles which are constant- 
 ly floating in it; and, though one of these objections may be 
 partially obviated, by placing water upon the stove, yet it will 
 not remove the second ; 4thly, the air is almost constantly in- 
 jured by substances thrown upon the stove, as grease, meat, &c; 
 5thly, there is always a temptation to do some kind of cooking 
 upon or in a stove, to the destruction of the comfort, or to the 
 injury of the health of the little inhabitants of the nursery, be- 
 sides the serious risk of scalding them, by heating water upon 
 it. We lately saw an instance of death from this cause, and 
 have witnessed many times minor accidents from the same 
 source. 
 
 377. We have already forbidden the performance of a num- 
 ber of operations in the nursery — we need not repeat them here 
 — we shall merely reiterate, that the nursery should be the 
 purest place in the house, as well as the one in which the chil- 
 dren should most delight to be. It should, therefore, never be 
 made a place of punishment, by banishing children to it for any 
 little delinquency, or inadvertence, they may have been guilty 
 of; but, on the contrary, a temptation should constantly. present 
 itself in the nursery, by making it the seat o*f their amusement: 
 children will then bear being placed there, without considering 
 it a place of confinement, or one in which they are to expe- 
 rience privations. 
 
 378. Among the proper provisions of a nursery, we would 
 reckon a small backgammon table, with men, but without dice. 
 Children, as soon as they are capable of comprehending the sub- 
 ject, should be taught draughts, or checkers. This game is not 
 only highly amusing, but it is also very instructive, as it calls 
 forth the resources of the mind in the most gentle, as well as 
 in the most successful manner. It becomes a source of endless 
 amusement, as it never tires, and always instructs. 
 
OF THE NURSERY. 115 
 
 379. Battledore, or shuttlecock, is also a proper game for the 
 nursery; this gives great agility, as well as great vigour, to 
 every muscle in the body. It exercises with but -little fatigue- 
 it gives great practical accuracy to the eye and to the hand ; 
 while the mind is agreeably amused. A large cup and bail should 
 be added to the above articles, as it affords great opportunities 
 for acquiring skill, as well as excites an agreeable emulation to 
 excel. 
 
 380. A rocking-horse, of a good size, should also be an append- 
 age to a nursery — this article, however, should be considered as 
 a luxury, or, it will become abused by becoming too familiar; it 
 should, therefore, only be introduced occasionally, and that, as a 
 reward for good conduct. This will teach children to find their 
 seat upon a saddle, much easier than they would otherwise do, 
 when they are placed upon the back of a living horse. 
 
 381. Slates and pencils, afford much employment, as well as 
 amusement to children — it gives them the habit of making let- 
 ters and figures very early, as well as calls forth their imitative 
 powers in rude attempts to copy any of the objects of nature, or 
 of art, which may present themselves. For the same reason, we 
 would indulge children in the use of paper and lead pencils. 
 
 382. To children of proper age, dissected maps, and Chinese 
 puzzles, or tangrams, are very acceptable, and highly useful : 
 they exercise the memory, elicit ingenuity, excite a laudable 
 emulation, and give the habit of patience and perseverance, in 
 their various attempts to correctly dispose of the one, or discover 
 the various combinations of the other. 
 
 383. A quantity of regularly shaped pieces of wood, of various 
 sizes, should also be given to them ; these they will arrange, and 
 that sometimes with great ingenuity, into houses, temples, churches, 
 &c, and thus become sincere admirers of each other's skill, in 
 forming these mimic, but evanescent buildings, the destruction of 
 which they ardently wish for, the instant they are formed ; and 
 whose sudden demolition, by a stroke of the hand, affords the 
 highest gratification, because they can construct another with 
 almost as much celerity. 
 
 384. A set of nine pins and balls of proper size, afford great 
 pleasure to children ; and serve to divert, as well as to exercise 
 them; for both of these are highly important, when the weather 
 prevents their being taken into the open air. By affording them 
 opportunities to exercise their skill, they forget they are con- 
 
116 OP THE NURSERY. 
 
 fined ; and thus is prevented that peevish discontent, called ennui, 
 by which they are sure to be assailed, when they have nothing 
 to exercise their muscles, or to employ their minds. 
 
 385. We might enumerate a number of other sources of 
 amusement to children, but almost every parent will supply the 
 deficiency, as the necessity for variety may present itself. We 
 do not, however, approve of sharp-edged or pointed instruments 
 for children — they can serve no possible use, and may be pro- 
 ductive of serious mischief. We have known the loss of two 
 eyes from pointed instruments, and a number of severe wounds 
 from sharp ones. 
 
 386. The nursery should be as free as possible from holes or 
 crevices, that the children may not be exposed to partial draughts 
 of air; and that the air of the room may be preserved in winter 
 of a pretty uniform temperature. Attention to this, will enable 
 the children to play in every part of the room, without injury; 
 and it will also prevent the desire to crowd round the hearth, 
 which will serve to diminish the risk of their clothes taking fire, 
 or doing themselves other injury. 
 
 387. Too much care cannot be taken to guard against the ac- 
 cident of the clothes taking fire; there is but one security against 
 this, when an open fire-place is the means employed for warm- 
 ing the room ; namely, by dressing the children in worsted gar- 
 ments, or, at least, the outer ones ; that is, the frocks and aprons. 
 It is but too common to disregard this important precaution; and 
 the accidents are numerous in consequence of the neglect. Many 
 are in the habit of dressing their children in proper materials, as 
 regards their body clothes, but seem altogether to forget, that, if 
 these be covered by a muslin or linen apron, it may take fire, 
 and do serious mischief; it is, therefore, not sufficient, that the 
 under garments be made of woollen materials, if these be sur- 
 mounted by an inflammable substance. 
 
 388. Children that can just run about, as well as older ones, 
 are almost constantly in the habit of having sharp-pointed sticks 
 for playthings ; and nothing is more common than to put an end 
 of one of these sticks in their mouths, and run with it when it 
 is in this situation, at the risk of doing great mischief to the 
 mouth and throat, by its being violently driven into them by the 
 force of a fall. My friend Dr. Physick, related to me a case of 
 lock-jaw, and death, from this cause; and we ourselves have 
 witnessed many less severe accidents from the same source; and 
 
OF THE NURSERY. 117 
 
 we were called, not long since, to an accident of this kind, that 
 created much anxiety, though it did well eventually. A child 
 was running across the floor with a pointed stick of cedar in its 
 mouth; it fell, and the point was forced through the palate, 
 which it nearly separated. It produced much suffering, from 
 an almost total inability to swallow from the inflammation that 
 was excited. 
 
 389. It is also wrong to permit children to run about the nur- 
 sery barefooted, or in their slocking feet, especially if the floor 
 be covered by either carpet or mat ; as it every now and then 
 happens that they run into their feet, needles, pins, nails, glass, 
 
 "or other sharp substances, that may be concealed in the sub- 
 stance of the floor covering. 
 
 390. The introduction of glass into the nursery should be 
 avoided as much as possible ; as a constant liability to accident 
 is incurred, by its being broken, and strewed over the floor, and 
 by the children treading upon, or handling the pieces. 
 
 391. We cannot recommend too earnestly the frequent ven- 
 tilation of the nursery. The best possible method to purify the 
 air, is by the admission of fresh air from without; this should be 
 done at least daily, by opening the windows and doors for a short 
 time. During the process of ventilation, however, the children 
 should be removed from the nursery, or protected by a skreen, 
 from the immediate current of air ; but the former is the better 
 plan, as children are not always obedient to the wishes of their 
 nurses, and may expose themselves very improperly. This ven- 
 tilation should not be performed, if the weather be wet ; as the 
 damp air might prove more injurious, than the air intended to 
 be removed. 
 
 392. No sand should be strewed upon the floor of the nursery ; 
 as it is always inconvenient to walk upon, as well as furnishing 
 a great quantity of very fine sharp dust, which is very injurious 
 to the eyes, when the floor is swept, or is otherwise disturbed. 
 
 393. Some have recommended fumigations of vinegar, and 
 other substances, for purifying the air ; this is neither necessary 
 nor availing, especially as we can always command a much bet- 
 ter article, namely, the fresh external air. 
 
 394. The air of a nursery should be maintained at a pretty 
 uniform temperature — for this purpose, a thermometer should be 
 a part of the furniture of every well appointed nursery. It 
 should be placed remotely from the fire, and not to face it ; as it 
 may, if so situated, give a false result, as it will be necessarily 
 
118 OF THE NURSERV. 
 
 affected by the radiant heat of the fire. It should never exceed 
 66 or 67° of Fahrenheit. The thermometer should be placed 
 out of the reach of the children, or it will quickly be destroyed. 
 
 395. We are fully persuaded that the excessive heat of nurse- 
 ries has occasioned a great mortality, especially among very 
 young children. In the first place it over-stimulates them ; and, 
 in the second, renders them so extremely susceptible of cold, and 
 every draught of cool air endangers their lives. They are main- 
 tained in a constant state of perspiration, which is frequently 
 checked, by an exposure to even an atmosphere of moderate 
 temperature. 
 
 396. Children should never be left alone — their helpless con- 
 dition requires constant care, especially when very young. They 
 should never be left to themselves while feeding, as they may 
 choke for want of proper and timely assistance ; nor should they 
 be placed upon a chair or table, unless they be well watched. 
 The children of the poor very often meet with serious accidents, 
 from the necessity the mothers are frequently under, to leave 
 them for a time to take care of themselves. A friend lately re- 
 lated to me a fatal accident, arising from this cause, which may, 
 perhaps, serve as a warning to those who are in the habit of 
 leaving children alone, when there is no absolute necessity to do 
 so. A poor woman, who had been spinning upon a large wheel, 
 was obliged to leave the room for a short time. Before she went, 
 she placed her child, (an infant who could not walk,) upon the 
 floor some distance from the wheel. She presently heard some- 
 thing fall, and her child to scream violently — she ran instantly 
 into the room, and found the poor infant transfixed to the fioor, 
 by the spindle of the wheel passing entirely through its body. 
 She supposed the child had pulled at the thread she had been 
 spinning, which was sufficiently strorfg to overset the wheel. 
 
 397. Animals should not be left with children when alone, for 
 both dogs and cats may be provoked to do mischief, if too rude- 
 ly assailed by them. Cats, by common consent, are driven from 
 the sleeping places of children, under an apprehension that they 
 will " suck the children's breath." If this phrase mean any 
 thing, it is that the animal can produce suffocation, by arresting 
 either the ingress or egress of the air — a thing altogether impos- 
 sible, unless the animal should have sagacity enough to stop 
 both the mouth and nostrils at the same time ; for, should the 
 mouth be closed, respiration can be carried on through the nos- 
 
OF THE NURSERY. 119 
 
 trils ; should the nostrils be obstructed, it will go on through 
 the mouth. 
 
 398. When a night lamp is burned, it should always be placed 
 in the chimney-place, or immediately before the door of a stove, 
 that the smoke may be carried off. If this be not done, the air 
 of the room becomes loaded with lamp-black, to the great in- 
 jury of the lungs. 
 
 399. It is not a matter of indifference, in which direction the 
 light falls upon the child; young children eagerly seek it with 
 their eyes ; and if it do not falPdirectly upon the face, the eyes 
 will be strained to the direction in which it is strongest. In con- 
 sequence of this, the muscles will contract the habit of moving 
 the eyes in an oblique direction, which may terminate in squint- 
 ing. On this account, all objects capable of attracting the at- 
 tention of the child from the vivacity of their colours, should 
 never be presented to them sideways, or immediately over their 
 heads. 
 
 400. We have already forbidden washing or ironing, or any 
 other operation being carried on in the nursery, which shall load 
 the air with vapour; as it will necessarily expose the children 
 to colds, coughs, or other severe affections of the lungs. 
 
PART II. 
 
 ON THE PHYSICAL TREATMENT OF NEW-BORN, AND 
 OLDER CHILDREN, &c. 
 
 401. For the sake of convenience, as well as of perspicuity, 
 we shall divide the consideration of the physical treatment of 
 children into the different and marked periods of their lives ; 
 that is, from the moment of birth, to the period of puberty. 
 These divisions will comprise, 1st, the period from birth to that 
 of weaning ; 2dly, from that period, to second dentition ; 3dly, 
 from second dentition, to the period of puberty. 
 
 CHAPTER I. 
 FIRST PERIOD. 
 
 402. Every child born alive, and at, or near the full time, 
 cries as soon as the surrounding air gains free admission into its 
 lungs. This grateful sound repays, in an instant, the suffering 
 mother, for her pain, her anxiety, and her peril; or, at least, it 
 produces a temporary oblivion of them. But, unaccustomed to 
 the sound, and having all her life attached the idea of pain to 
 the exercise of the functions of crying, she becomes alarmed, 
 should this effort be continued any time, and most anxiously in- 
 quires " why the child cries so violently?" 
 
 403. We will endeavour to explain, for her sake, this interest- 
 ing question. The child, while in the womb, is surrounded by 
 water, and is enclosed within walls, if we may so term them, of 
 limited extent. In the first, it floats securely, as it has no use 
 
OF CRYING. 121 
 
 for its lungs, while thus imprisoned ; and against the second, it 
 oftentimes tries the strength of its limbs, with much advantage 
 to itself, if not always with comfort to its mother. As the me- 
 dium in which it floats is of the same temperature as that of its 
 mother's body, it may be considered as constantly living in a 
 warm bath. The uses of this bath are, 1st, to preserve the child, 
 as much as possible, from external accidents ; 2dly, to give en- 
 tire freedom to all its movements ; 3dly, to maintain it in a me- 
 dium of uniform temperature ; and 4thly, to preserve the sup- 
 pleness and sensibility of its skin. 
 
 404. When the little stranger is ushered into the world, how 
 changed are all its relations, and all its necessities ! It now be- 
 comes almost an independent, though a most helpless being ; for 
 its immediate connexion with its mother is at once cut off; in- 
 stead of a bath of the most grateful temperature, it is plunged 
 into an atmosphere almost always a little lower than the one it 
 has been in the habit of revelling in; and sometimes into one, 
 very much below it: and instead of the confined surface against 
 which it was wont to exercise its sense of touch, it is now thrown 
 comparatively into illimitable space. The first of the changes 
 we have mentioned, makes a powerful, and doubtless, some- 
 times, a painful impression upon its extensive surface of skin. 
 Its little muscles are necessarily thrown into action ; and, as a 
 consequence, the chest becomes expanded, and the air by which 
 it is now surrounded, enters its collapsed lungs, and the action* 
 of " crying," is instituted. 
 
 Sect. I. — Of Crying* 
 
 405. " Crying" should be looked upon as an exercise of much 
 importance, both to the immediate, and mediate advantage of 
 the being. Immediately it is useful, by facilitating the passage 
 of blood through the lungs, where, until this moment, it had been 
 unaccustomed to travel ; but which is now a sine qua non to the 
 existence of the being ; 2dly, it serves more effectually to the 
 expansion of the air cells of the lungs ; thereby presenting a 
 larger surface for the action of the atmospheric air, from which 
 the most important consequences are to flow ; such as the due 
 oxygenation of the blood, on which depends, to a greater orJess 
 extent, every healthy function of the system ; of the unloading 
 
 16 
 
122 OF CRYING. 
 
 of the system of certain materials, the retention of which would 
 be highly injurious ; and thus contributing either to the direct 
 or indirect production of animal heat. The mediate advantage 
 of " crying," consists in its giving strength and a proper tone to 
 the organs employed in the act, by thoroughly expanding the 
 air cells" of the lungs ; thus early and constantly accustoming 
 them to be stretched, at a period the most favourable for this 
 extension; and, at the same time, freeing the lungs from mucus 
 that is constantly pouring into these cells ; and thus preventing 
 injurious accumulations. 
 
 406. It may be farther observed, on the subject of " crying," 
 that this act is not always an expression of pain ; it is intended 
 very often as an appeal to the tenderness of the mother, when 
 the child is impelled to make its necessities known — hunger and 
 thirst, or sometimes, upon much more important occasions to it- 
 self, namely, uneasiness, from want of change of posture : for 
 a constrained situation, renders the child not only uncomforta- 
 ble, but is really injurious to it, if too long continued. The poor 
 infant is too often condemned to one position, provided it express 
 no objection to it by its cries; the consequences are, 1st, that 
 the circulation is much impeded on the side on which it lies, 
 from the compression the parts must suffer from the weight 
 of the child itself; and 2dly, its limbs are unequally exercised, 
 especially when the mother, or nurse, has a favourite side for the 
 child to rest upon — this election should never be suffered, for 
 reasons too obvious to need mention. We may, however, ob- 
 serve en passant, that the child should not be permitted to con- 
 tinue longer than an hour or two, at farthest, in any one posi- 
 tion ; the fear of awaking it should never prevent an attention 
 so important to its health. Besides, we know from ample ex- 
 perience, that the child very soon becomes accustomed to the 
 operation of turning, or changing its position, and will be al- 
 most sure to express the relief this alteration affords, by in- 
 stantly putting all its little limbs upon the full stretch, and again 
 " addressing itself to sleep." 
 
 407. We would particularly warn mothers and nurses against 
 placing the child upon its back ; as this position may be followed 
 by very serious consequences, if it chance to throw up the con- 
 tents of its stomach — we once knew suffocation from this cause. 
 
 '408. In very young children, there is a rapid accumulation 
 
OF SLEEP. 123 
 
 of the excitability of the system, arising from their passive con- 
 dition, which requires the employment of the muscles, to keep 
 it down to the healthy point; and " crying " is the " waste gate " 
 to an excess of excitability. This act, therefore, is more easily 
 provoked in children, that the equilibrium of excitement and 
 excitability may be preserved. " Crying " is most useful, in 
 many instances, for the same reason, even to the adult — who 
 has not witnessed the relief afforded by a gush of tears, to an 
 oppressed heart !• — and, in our practice, we take advantage fre- 
 quently of this circumstance, by permitting, nay, sometimes so- 
 liciting " cries " at the trying and important moment of a wo- 
 man becoming a mother. 
 
 409. To show, farther, the importance of this act, by creating 
 a diversion of the excitability and excitement, Dr. Rush used to 
 relate to us in his lectures the case of a gentleman in South Ca- 
 rolina, who was about to be cut for the stone. This gentleman 
 thought it beneath the dignity of a man, to express pain upon 
 any occasion ; he, therefore, refused to submit to the usual pre- 
 caution of securing the hands and feet by bandages, declaring 
 to his surgeon, he had nothing to fear from his being untied, as 
 he .would not move a muscle of his body — and he truly kept 
 his word; but he died instantly after the operation, from apo- 
 plexy. In this case the excitability and excitement were too 
 much accumulated in the brain ; and it yielded to their influence 
 from the want of some outlet for the one, or diversion for the 
 other. 
 
 410. But, in attaching so much consequence to " crying," we 
 are not to be supposed to advise either the provoking of it, or 
 perpetuating it, by artificial means ; nor to consider this act as 
 always expressive of either pain, or uneasiness, or to require 
 the interference of the mother or nurse; for, on the contrary, 
 we are fully aware how readily a habit of crying is generated, 
 by a too prompt attention to the demands of the child ; and, also, 
 that the most clamorous children are those you are the most 
 solicitous to appease. Crying may, however, be indicative of 
 disease ; it will, therefore, be considered again under this head. 
 
 Sect. II.— Of Sleep. 
 
 411. New-born children maybe said to sleep constantly ; their 
 waking moments furnish but exceptions to the rule. This is a 
 wise regulation of nature, since it permits a renewal of the ex- 
 
 H 
 
124 OF SLEEP. 
 
 citability, as fast as it is expended. In this early stage of life, 
 the gastric, the arterial, and the absorbent powers, are much 
 employed for the purposes of digestion, of secretion, of deposi- 
 tion, or growth; and, consequently, much excitability is re- 
 quired for the various contingencies now mentioned. And, it 
 would seem, in general, more is generated, if we may so express 
 ourselves, than is absolutely necessary, as it has to be carried 
 off, as just noticed, by occasional crying, &c. This passive con- 
 dition of new-born children is highly favourable to the healthy 
 expansion of the body, for, where this is interrupted by some 
 derangement of the nervous system, which declares itself by 
 too frequent crying, and watchfulness, the child ceases to thrive. 
 
 412. It is some time before the nerves of hearing appear to be 
 affected by sound ; hence, we see children almost insensible to 
 loud noises, even weeks after their birth. This appears to be 
 an especial care of Providence, that the important state of sleep 
 should not be too easily interrupted. This sense, however, af- 
 ter a time, becomes exquisitely sensible ; and, if it were to be too 
 much indulged, by not permitting the child to become familiar 
 to it, and that as early as possible, much mischief would arise. 
 
 413. We have often been consulted upon this occasion : over- 
 careful mothers think, that sleep should never be abridged, nor 
 interrupted; they, therefore, keep their nurseries so extremely 
 silent during the sleep of the child, that it is constantly awakened 
 in much alarm, whenever any sudden or unexpected noise as- 
 sails its ear; we have known children many times rendered so 
 sensible to noise during sleep, as to be roused by even a light 
 tread upon the floor ; and when a louder noise had been made, 
 to awake almost in convulsions, and always in extreme fright, 
 and loud crying. To guard against these evils, and they are 
 evils of much greater magnitude than might at first sight ap- 
 pear, since, in many instances, they have been perpetuated 
 through life, we therefore, constantly recommend, as a practice 
 in all nurseries, to let the child fall asleep in the midst of noise, 
 and never to consign the room to strict silence, as a precaution, 
 during the whole of its nap. If children be habituated to fall 
 asleep while surrounded by noise in the nursery, and not have 
 that noise interrupted by design during the continuance of sleep, 
 they will soon support any common degree of it, without the 
 least agitation, or other inconvenience. 
 
OP THE NECESSITIES OF THE CHILD. 125 
 
 '.414. Much advantage is derived from this plan — 1st, a mor- 
 bid sensibility of the organs of hearing is not generated ; conse- 
 quently, the child will be exempt from all the evils, and incon- 
 veniences, this condition would inflict ; 2dly, the functions of 
 the body will be better performed, since they will not be inter- 
 rupted by the repeated wakings of the child ; 3dly, the child 
 will derive all the advantages which an undisturbed sleep will 
 give ; 4thly, we can better calculate on the duration of its 
 sleep ; 5thly, it will save its mother or nurse much unnecessary 
 anxiety, as well as trouble. 
 
 415. If the habit of stillness during sleep have been established 
 in the nursery, the quicker it be broken the better ; this, if pro- 
 perly attended to, can be done in a short period ; 1st, by obliging 
 the child to fall asleep during a moderate noise, by not abstract- 
 ing the noise from it — it will contend, for some little time, but 
 not long ; 2ndly, by continuing the noise during the period of 
 sleep : by this plan, it will soon become familiar to it, and after 
 awhile may even sleep better than before. 
 
 Sect. III. — Of the Necessities of the Child. 
 
 416. The necessities of the child, are no less remarkably 
 changed than its relations. It must now breathe a pure air, or 
 it dies ; it must now receive and prepare food by the operation 
 of its own stomach, for the purposes of its system, or it sinks ; it 
 must now be protected against the variations of temperature, or 
 it perishes. In a word, a new kind of life commences from 
 this moment ; and, that this may be preserved in the best pos- 
 sible manner, is the end and object of Physical Education. It 
 will now be easily understood, why this species of education 
 should commence at the period we have assigned to it ; since it 
 will be obvious, that the more perfect the health of the individu- 
 als who marry is, the better the foetal life has been conducted, 
 the more successful will physical agents be, in properly deve- 
 loping, and perfecting the animal life, which is to follow. 
 
 417. It will be seen that the body is now to be subjected to 
 the influence of entirely new agents ; and these may be considered 
 under several distinct heads, as follow — 1st, Air; 2dly, Food; 
 3dly, Clothing ; 4thly, Exercise ; 5thly, Cleanliness. The agents 
 we have just enumerated exert a prodigious influence upon the 
 
126 OF THE AIR. 
 
 welfare of the being, on whom they are to act : their operations 
 commence with the first moments of animal life : and they are 
 perpetuated, under one modification or another, to the last, pe- 
 riod of human existence. We shall, therefore, take up the con- 
 sideration of each of these powers, in the order we have placed 
 them — and, first, of Air. 
 
 CHAPTER II. 
 
 OF THE AIR. 
 
 418. By the air, we mean that immense mass of permanently 
 elastic fluid, which surrounds the globe we inhabit. This sub- 
 stance is absolutely essential to the continuance of life in every 
 species of animal ; and its effects upon the human system are 
 healthy, or otherwise, in proportion to its purity* But this con- 
 dition must be constantly varying, as it may lose one of its 
 principles, or as it may receive an excess of another ; or be 
 loaded with noxious exhalations, from vegetable, animal, or 
 mineral substances, especially in great cities. 
 
 419. Modern chemistry has done much to illustrate the con- 
 dition of our atmosphere, by pointing out the means by which it 
 retains its vital purity, as well as by informing us in what this 
 vital purity consists, and the manner in which it becomes de- 
 teriorated. Until the discovery of oxygen as a component part 
 of our atmosphere, it was altogether conjecture, as to what it lost 
 or gained, by combustion, respiration, or vegetation. The phe- 
 nomena, of combustion and of respiration, were well marked 
 and described by the ancients ; but their reasoning upon the 
 causes of the changes which the air underwent by these pro- 
 cesses, was altogether founded upon assumed principles ; and 
 the world was not much enlightened upon this subject, until 
 oxygen was simultaneously discovered, by Scheele in Sweden, 
 and Priestley in England, to be a constituent of the atmosphere ;* 
 
 * It was soon found, after the discovery of oxygen, that this substance is es- 
 sential to combustion; and, very quickly after, that it is equally so to respiration. 
 
OF THE AIR. 127 
 
 though Mayo, two hundred years before, had nearly arrived at 
 the same discovery and conclusion. 
 
 420. For the discovery of the chief means by which the at- 
 mosphere maintains its purity, we are indebted to the experi- 
 ments of the ingenious Dr. Ingenhouz. He found, that plants of 
 every kind, while growing, and acted upon by the sun, yielded 
 this salubrious air — the deadly nightshade, and the most inno- 
 cent plant, alike gave out this gas. 
 
 421. There is, therefore, every reason to believe, that the at- 
 mosphere in its extended sense, is as pure now as in the days of 
 the patriarchs. If, then, life be shorter now than it was at that 
 period, (a circumstance, perhaps, wanting proof,*) it is certainly 
 
 Priestley made many decisive experiments upon this point — and, since the term 
 of vital air was given to it, as one of synonyma. 
 
 * Huffland says, " It is commonly believed, that during the early periods of the 
 world, the lives of its inhabitants were more youthful and more perfect? that 
 these primitive men had a gigantic size, incredible strength, and a most astonish- 
 ing duration of life." " Some have not hesitated seriously to ascribe to our fore- 
 father Adam, the height of nine hundred yards, and the age of almost a thousand 
 years. But the rational and accurate investigation of modern philosophy has 
 converted the supposed size of giants, found in different parts of the world, into 
 those of the elephant, and rhinoceros, (and, we may now add, the mammoth,) 
 and acute theologists have shown, that the chronology of the early ages was not 
 the same as that used at present. Some, particularly Hensler, have proved, with 
 the highest probability, that the year, till the time of Abraham, consisted of only 
 three months; that it was afterwards extended to eight; and that it was not till 
 the time of Joseph, that it was made to consist of twelve. These assertions are, 
 in a certain degree, confirmed by some of the Eastern nations, who still reckon 
 only three months to the year." But, however much calculators may differ in 
 the supposed ages to which antediluvians may have attained, we have strong rea- 
 sons for believing, that in the time of Moses, the chronology was, perhaps, abso- 
 lutely the same as at the present moment. This opinion, however, we must con- 
 fess, is deduced rather from circumstances , than absolute facts; and relies for its 
 support, almost altogether, upon analogy. Thus, Moses informs us, ** The days 
 of our years are threescore and ten; and if, by reason of strength, they be four- 
 score years, yet is their strength labour and sorrow; for it is soon cut off, and we 
 fly away," Ps. xc. Again, in the time of David, five hundred years after Moses, 
 when Barzillai excuses himself for not visiting the royal palace at Jerusalem, he 
 observed to the king: — 
 
 "I am this day fourscore years old, and can I discern between good and evil? 
 Can thy servant taste what I eat, or what I drink? Can I hear any more the voice 
 of singing men, and singing women? Wherefore, then, should thy servant be 
 yet a burden unto my lord the Ym^V —American Quart. Rev. J\ 7 o. 16, p. 364. 
 
 From this it would seem, that at that time the age of fourscore was an excuse 
 for the neglect of ceremonious duties; since it appears to have been attended 
 
128 OF THE AIR. 
 
 ■ 
 
 not owing to a defect of purity in the general atmosphere. It 
 must have its foundation in circumstances, independently of any 
 general atmospheric impurity. 
 
 422. These circumstances, we are of opinion, are the changes 
 in the habits and manners of mankind at present, from those in 
 the time we have just alluded to. Formerly, man was simple 
 in his mode of life, and laborious in his habits; his occupations 
 were confined very much to those of the hunter, the shepherd, 
 or the tiller of the earth. 
 
 423. From this it would seem to be ascertained, that air may 
 be either pure, or be more or less deteriorated, as it may be 
 subjected to such causes, as may be capable of altering its 
 chemical, or sensible properties. The chemical properties of 
 the air are principally affected by combustion, and by respira- 
 tion ; and the changes which it may undergo, are in proportion 
 to the extent or degree of the one, or the continuance of the 
 other. 
 
 424. But, to make this better understood by those who have 
 never devoted any time to the subject, it may be necessary to 
 state, that the " atmospheric air " is principally composed of 
 two distinct substances or gases, in certain proportions to each 
 other. One of these is called oxygen, the other nitrogen. It 
 is the former which maintains combustion and supports respi- 
 ration; for these processes can be continued as long as this 
 exists in the combination, and the perfection of either will de- 
 pend upon the due proportion of oxygen. It must, however, 
 be remembered, that an excess of oxygen does not do any ma- 
 terial injury to either. 
 
 with all the defects, now common to the age " of fourscore :"™impaired moral 
 perception; diminished taste, or appetite; loss of sight; and hardness of hearing. 
 It would, therefore, be safe to conclude, that longevity was not greater than that 
 in our own times. Indeed, we might even plead improvement, agreeably to the 
 following statements:—" The census, established from time to time in England, 
 affords us information of an unquestionable kind. The first actual enumeration 
 of the inhabitants, was made in the year 1801. It gave to England and Wales, a 
 population of 9,168,000, and a mortality of 204,434, or 1 in 48. The second 
 was made in 1811. The population was then 10,502,900, and the mortality 1 in 
 50. And the third and last, which took place in 1821, gave an enumeration, ac- 
 cording to Mr. Rickman, (who was appointed by the secretary of state for the 
 home department, to digest and reduce into order the population returns, and by 
 the privy council to arrange the parish register returns,) of 12,218,500, and a mor- 
 tality of 1 in 58."~And this might be extended toother countries.— Jlmer. Quart. 
 Jkv. No. 16, p. 388. 
 
OF THE AIR. 129 
 
 425. Now, as combustion and respiration are always going 
 on in the habitable world, it follows, there must be a constant* 
 loss of oxygen ; and if there were no sources or means, by which- 
 it could be supplied, the " atmospheric air " would be constantly 
 suffering deterioration, even until it were exhausted of its vital 
 principle. But a kind Providence has permitted a supply of 
 oxygen in as great proportion as it is taken from the atmos- 
 phere ; and b}^ new processes, its qualities in a general sense are 
 maintained at all times, in pretty nearly the same degree of 
 purity. 
 
 426. The. means by which the lost oxygen is supplied, are 
 no less certain than extensive; thus, all the living vegetable world 
 emit it, as long as they are operated upon by sun-shine; and the 
 decomposition of water furnishes another extensive source of sup- 
 ply. 
 
 427. From what has been said, it will readily appear, that com- 
 bustion and respiration, which is, in fact, a kind of combustion^ 
 tend to diminish this vital property of the air ; and in proportion 
 to that loss, it is unfit to maintain either: it must be, therefore, 
 evident, that the air which has been once breathed, is less fit for 
 another operation, in the exact proportion to the diminution of 
 the oxygen it may have contained ; and, if this process be suf- 
 ficiently long continued, it will be entirely exhausted, and in its 
 place will be found a quantity of carbonic acid gas, equal to the 
 removed quantity of oxygen, combined with the usual or ori- 
 ginal bulk of nitrogen ; neither of which is respirable alone. 
 Hence, the air of great cities is necessarily less pure than that 
 of the surrounding country — 1st, by having more causes con- 
 stantly operating to destroy its chemical, and to alter its sensi- 
 ble qualities; and, 2dly, by having fewer means to restore the ex- 
 pended oxygen, and to abstract from it its carbonic acid gas, &c- 
 
 428. Independently of the greater consumption of vital air* 
 and the inadequate means in great cities to supply it, there are 
 other causes constantly operating to render it still more impure, 
 than respiration alone. Combustion, fermentation, and exhala- 
 tions from putrid and other bodies, all tend to deteriorate the 
 already too much impaired air; and, consequently, will render 
 cities less healthy than the surrounding country, and, perhaps, 
 pretty constantly in trie-proportion we have mentioned. 
 
 429. Therefor^ it is' no way surprising, that the mortality 
 
 17 
 
130 OF THE AIR. 
 
 among children should be excessive in cities, since their stamina 
 are incapable of supporting either the loss of so much oxygen , 
 or the influence of the various miasmata by which they are con- 
 stantly surrounded — hence, agreeably to calculation, more thai* 
 one-half of those who are born, die before the third year. It is 
 true we must not attribute this excessive mortality exclusively 
 to the causes just mentioned ; there are others constantly ope-^ 
 rating to produce this effect, especially among the poor ; such 
 as bad nursing, and perhaps worse feeding. 
 
 430. Rousseau, with a mixture of truth and prejudice, in- 
 veighs bitterly against men shutting themselves up in cities — he 
 says, " Mankind were not formed to be heaped together in shoals, 
 but to spread themselves over the face of the earth, to cultivate 
 it. The more they assemble together, the more they corrupt 
 each other. Man is, of all animals, the least adapted to live in 
 herds. Flocks of men, like flocks of sheep, would all perish in 
 a short time* Their breath is destructive to their fellow crea- 
 tures; nor is it less so in a literal, than in a figurative sense." In 
 these few sentences we see at once his plan of education, and the 
 impossibility of reducing it to practice ; for all could not become 
 cultivators of the soil, any more than they could be all shoema- 
 kers or tailors. And, though we admit that cities are less healthy 
 than the country, yet all men could not live in the country ; and 
 cities ever have, and always will be built from the very nature 
 of things. Nor is it difficult to foresee the consequences, should 
 the genius of man tempt him to spread himself widely over the 
 face of the earth, and all become cultivators of the soil ; other 
 evils would necessarily arise, which would be equally destruc- 
 tive of human life. 
 
 431. Look at man in this condition, wherever he maybe 
 found, and what is it we see? Neither a more rapid increase of 
 population,, more brotherly love, greater longevity, nor greater 
 improvement of the soil ! And, though we admit there may be 
 a greater exemption of disease in the country, it does not se- 
 cure a greater share of either happiness or population. Indeed, 
 if we may credit what is found in books upon the relative con^- 
 ditions of man in a savage and in a civilized state, it would ap- 
 pear, that cultivation of the mind is even favourable to longevi- 
 ty ; and though there may be more general health in a savage 
 state, there is less length of life. The instances of longevity 
 
OF THE AIR. 131 
 
 among our aboriginals are fewer, than in refined life; so that 
 what one gains by a greater freedom from disease, the other ac- 
 quires by an increase of years. Rousseau's scheme of happiness 
 for man, is, therefore, altogether Eutopian. 
 
 432. In this country, the evils of cities are more limited than 
 in those of Europe: they are, first, less populous; 2dly, they are 
 better ventilated, by the breadth and regularity of their streets ; 
 3dly, there are much fewer manufactories carried on in them ; 
 4thly, there is less poverty, or in other words, there are greater 
 facilities of life. 
 
 433. During the summer, our cities become unfriendly to our 
 ■very young population, and much benefit is derived by carry- 
 ing them into the country, when health has failed in the city. 
 But this favourable change is not owing altogether to the purity 
 of the country air ; much depends upon taking children from the 
 remote causes which produce the disease. That this is the 
 case in many instances, we are entirely convinced by the fact, 
 that children attacked with disease in the country, are very often 
 benefited by their being brought to the city— this is familiar to 
 every practitioner, as well as to very many others who are not 
 physicians. 
 
 434. We are also certain that the country air is not made the 
 best possible use of, by those who inhabit cities ; for no sooner 
 does the warm weather commence, than they leave the city; and 
 this when the children are in perfect health. In consequence of 
 this, they become accustomed to the air of the country, as well 
 as liable to any epidemic, or local influence that may exist there. 
 The object of leaving the city is now defeated ; since it cannot 
 preserve health to those who fly to it for refuge; and it is found 
 cceteris paribus, as difficult to cure a disease originating in the 
 country, as in the city — nay, as we have observed above, the pa- 
 tients are sometimes obliged to return to the city to get well. 
 
 435. We are persuaded, those who profit most by the change 
 of air, are those who repair to it as a remedy: children who have 
 suffered, or are about to suffer from the heat of our cities, de- 
 rive immediate, as well as permanent advantage from the change; 
 but when taken to the country early in the season, they appear 
 to us to be as liable, or nearly as liable to disease, as if they had 
 remained in the city. Nor is this to be wondered at: they 
 are surrounded by the remote causes which produce disease in 
 the country; (for no one will deny that the country is not ob- 
 
132 OF THE AIR. 
 
 noxious to diseases as well as the city,) besides being liable to ex- 
 posure to dews, both in the morning and evening, under the pre- 
 tence, that a walk early in the morning, as well as in the evening, 
 is wholesome ; as if wet feet and draggled skirts, would not de- 
 stroy all the advantages of these early and late walks. They 
 are surrounded by the temptation of fruit in all stages of imma- 
 turity, which we well know they do not resist ; but, on the con- 
 trary, they literally cram themselves to surfeit, more than once 
 in the twenty-four hours. Need we wonder at their being at- 
 tacked by disease? 
 
 436. We have every reason to believe, that were proper at- 
 tention bestowed upon children during the period of teething ; if 
 proper regard were paid to their food; if due pains were taken 
 with their clothing ; and if a well-regulated system of exercise 
 were established ; there would be much less occasion for country 
 excursions, for the benefit of health. We shall attempt to ex- 
 plain these various and important topics in the course of our 
 present work, and in such a manner, as will make the putting 
 of them in practice easy to every understanding. ' 
 
 437. Rousseau, in his ardour to recommend a country life, be- 
 comes, like most speculators upon human conduct, inconsistent 
 with himself. His first great object is, to oblige every mother 
 to suckle her own child ; yet he says, they must " send their 
 children to regenerate themselves in the country." Is it prac- 
 ticable for every mother to retire to the country during the first 
 two or three years of their children's lives'? — or to desert their 
 home and families, as her children may present themselves ? If 
 they cannot do this, they must, agreeably to this scheme, com- 
 mit the charge of their children to hirelings ; the very thing he 
 so loudly deprecates. Of the same nature is his advice to preg- 
 nant women ; when he recommends them to lie-in in the coun- 
 try, instead of returning to the city for this purpose. How few 
 could do this without creating greater evils, than it is even in- 
 tended to cure? But to return. 
 
 438. The proportions of these gases in forming the atmosphere, 
 are as follows : in one hundred parts of atmospheric air, there 
 are of 
 
 .Oxygen, 20 parts, 
 Nitrogen, 80 do. 
 
 100 
 
OF THE AIR. 133 
 
 These proportions, we are aware, are not rigidly exact ; but 
 they are so nearly so, as to render a mention of their fractions 
 unnecessary, when treating this subject in a general manner. 
 
 439. It must, however, be recollected, when we speak of an 
 impure air or atmosphere, we are not to be supposed to mean, 
 strictly, a mere diminution of oxygen ; for the air may be so 
 filled with impurities as to render it highly dangerous to be 
 breathed without its oxygen being diminished in the smallest 
 degree. Thus, marsh miasmata, the contagious principle of 
 small-pox, measles, &c, may be floating in an atmosphere 
 which may have its oxygen in full proportion. And it must be 
 farther observed, that a full proportion of oxygen does not, by 
 any means, prevent the influence of these noxious qualities upon 
 the human constitution. It is, therefore, necessary to distin- 
 guish between an impure air, and an irrespirable one ; the one 
 giving rise to disease, the other preventing respiration. 
 
 It may be asked, if this be true, of what advantage is the 
 oxygen of the atmosphere to the human constitution, if it have 
 not a conservative power ? The answer is as easy as it is sa- 
 tisfactory. Experiment has clearly proved — 1st, that this sub- 
 stance is absolutely necessary to respiration ; and respiration 
 is essential to life ; 2dly, that this gas performs also important 
 offices within the system ; for, should the blood not be duly 
 supplied with this fluid, it would be rendered unfit for the pur- 
 poses of the circulation ; consequently, all the functions depen- 
 dent upon this process must be imperfectly performed, and life 
 itself would soon cease. 
 
 440. But it would be an error to suppose that the more there 
 is of oxygen, the better for animal life. This is by no means 
 true : since this gas is so ethereal and stimulating, as, if too free- 
 ly indulged in, to make us live too fast. We can give abundant 
 proof of this in the air of the Glaciers, which is of the greatest 
 purity, but is rather prejudicial to health. In it we consume too 
 fast, if we may be allowed to retain the figure, that respiration 
 is a combustion : and the temperature is also too variable. 
 
 441. Besides, Switzerland, the highest land in Europe, fur- 
 nishes fewer instances of longevity than Scotland; and the 
 causes of this are obvious — 1st, the atmosphere, at all great 
 heights, is too dry ; consequently, too much moisture is de- 
 tracted from the body ; as its capacity to receive our fluids, 
 and hold them in solution, is in proportion as it may be free from 
 
134 » or THE AIR. 
 
 from them ; 2dly, the variableness of the temperature, which al- 
 ways obtains in high situations, is extremely prejudicial to the 
 duration of life. 
 
 442. On this account, islands and peninsulas are more favour- 
 able to long, life than continents. For the temperature of the 
 atmosphere is much more certainly preserved in the former than 
 on the latter ; and the sensible qualities of it have a very decided 
 influence upon animal life. The weight and temperature of the 
 air, and especially the uniformity of these, have a great effect 
 upon the human body. Wherever these are the most uniform, 
 it will be found, (cceteris paribus,) most favourable to old age — 
 hence, we are told that men live longer in the islands of the 
 Archipelago, than in the neighbouring countries of Asia ; in Cy- 
 prus, than in Syria ; in Formosa, than in Japan and China ; and 
 in England and Denmark, than in Germany. 
 
 443. From what we have said, it would appear, that the 
 healthfulness of a place is not to be determined by the purity of 
 the air ; or rather by the quantity 'of oxygen which may enter 
 into its composition ; therefore, something else is required, as 
 we have already attempted to show : such as location, soil, cul- 
 tivation, &c. And, farther, that oxygen, as before suggested, 
 cannot interrupt the action of various poisons, especially such as 
 may be considered the remote causes of fever. Yet, this fluid 
 is indispensable as a constituent of the air ; and though its pre- 
 sence cannot protect against disease, yet its absence is certain 
 death to the animal that is obliged to breathe an atmosphere 
 from which this has been withdrawn, or is already consumed. 
 
 444. Hence, great cities are so unfavourable to the extension, 
 or even the continuance of human life. It is calculated that in 
 London, Paris, Vienna, and Berlin, between the twentieth and 
 twenty-third part of the population die annually ; while in the 
 surrounding countries, the mortality does not exceed a thirty- 
 fifth or fortieth part. This difference in the mortality of the re- 
 spective places just mentioned, is, however, in a great measure, 
 owing to the destruction of too large a portion of oxygen. If 
 the population become still more dense, the mortality is still 
 greater ; and when many are crowded together, as in ships, and 
 prisons, the destruction is yet greater ; and if the quantity of air 
 be still more limited, the effects are awful ; as was witnessed in 
 the Black Hole of Calcutta, where a hundred and forty-six men 
 
OF THE AIR. 135 
 
 were confined in a narrow space for twelve hours, out of which 
 number a hundred and twenty-three died. 
 
 445. It is, therefore, evident, that no greater mischief can be 
 offered the human lungs, than the want of a due supply of oxy- 
 gen; consequently, the cruel and absurd practice of covering the 
 head of a new-born child, or very young children under the bed 
 clothes, cannot be too severely reprehended. The consequences 
 of this practice can be readily anticipated, from what has already 
 been said ; though it may carry conviction more readily, to ex- 
 plain the changes which constantly take place, when the child 
 is so circumstanced. In placing a child under cover in the man- 
 ner just mentioned, it must, necessarily, be placed in a space with 
 a limited quantity of air. Of this quantity, a certain portion is 
 drawn into its lungs by every inspiration, and returns it again 
 with a loss of a part of the oxygen ; the place of the oxygen is 
 supplied by an equal quantity of that noxious, or irrespirable 
 gas, called " carbonic acid gas." Another, and another quantity 
 is taken in, with precisely similar results, until by the repetition 
 of this process, every particle of oxygen is abstracted, and its 
 place as constantly 'supplied by carbonic acid gas ; and this not 
 being respirable, the child dies, unless it be timeously exposed to 
 fresh air. 
 
 446. An objection as serious may be made to the habit of 
 many women, of keeping the child at the bosom all night, with 
 its head closely covered with the bed clothes : the objections just 
 urged, will operate with equal force in this as in the former in- 
 stance; as there is constantly emanating from the surface of every 
 living body, a sensible and insensible perspiration, as well as- 
 an extrication of carbonic acid gas. If the body be covered 
 closely, and the escape of this gas prevented, the air surround- 
 ing the body, thus covered, is very soon found unfit for the pur- 
 poses of respiration.* Therefore the child is oftentimes plunged 
 into an atmosphere already rendered impure by the body of the 
 mother or nurse, and, consequently, in a short time, has less oxy- 
 gen than is necessary for the purposes of respiration ; and it pe- 
 
 * If a candle be placed beneath the bed-clothes alongside of a person that has 
 been closely covered all night, it will be quickly extinguished, from the excess 
 of carbonic acid gas. 
 
136 OF THE AIR. 
 
 rishes even at its mother's bosom. We have witnessed four 
 instances of death from this cause.* 
 
 447. It will be easily deduced, that every deterioration of 
 the air must be injurious to the child, precisely in the propor- 
 tion to the degree; consequently, the utmost care is required,, 
 that no unnecessary process by which the air can be injured^ 
 should be carried on in the room or nursery, in which the child 
 is kept. Hence, the decided impropriety of too crowded a 
 room ; of washing, drying, and ironing the things intended' for 
 the child or children's use ; permitting the wet or soiled- articles? 
 taken from the child to remain long in the room ;. burning of 
 charcoal or other combustible substances outside the chimney 
 place; cooking of the various articles for meals y the too fre- 
 quent wotting of the floor; smoking of tobacco; burning of oil, 
 with too long a wick, &c. In a word, the nursery should be, 
 if possible, the purest place in the house. We have had occa- 
 sion already to advert to this subject, when treating on the nurse- 
 ry ,—(350, &c.) 
 
 448. We cannot well condemn, too severely, the -filthy prac- 
 tice, in too many nurseries, of drying the wet and soiled articles 
 in the room with the child. If an article must be used a second- 
 time after having been once wetted, it should, at least, be re- 
 moved from the nursery for the purpose of drying. But a 
 much better practice would be to consider a well wetted diaper 
 as unfit for reapplication, until it has been washed. The same 
 may be said of every other article belonging to the child, that 
 has been wetted by its discharges ; as its petticoats, sheets, bed,, 
 mattress, &c. 
 
 449. The value of a pure atmosphere, does not cease at any 
 period of the child's life ; it is highly important at all times ; 
 though, perhaps, not so immediately essential, as during the first 
 few days of its existence, as it is then less able to bear an im- 
 pure air, than when it becomes older. 
 
 If the directions we have just given be attended to, many 
 sources of impurity will be removed, yet it will not amount to- 
 
 * We cannot better illustrate the injurious consequences arising from this prac- 
 tice, than by stating, that in Great Britain alone, there perished forty thousand 
 children, by the practice of nurses permitting the children to sleep near them 
 from the year 1686 to .l8QQ.-~~Frledl(mder , s Education Physique. 
 
OP TEMPERATURE. 137 
 
 Absolute security. Therefore, frequent ventilation is of much 
 Consequence ; by this the great mass of the air is removed, and 
 its place supplied by that of a better quality. In doing this, 
 however, some care is necessary, or the child may receive in- 
 jury, by either partial streams of air passing over it, or by 
 having one of too low a temperature applied to it. 
 
 Sect. 1»— Of Temperature. 
 
 450. Children of tender age, should never be suddenly sub- 
 jected to great changes of temperature,* whetlier the change be 
 from a higher to a lower one, or the reverse ; therefore, chil- 
 dren born in a cold climate, and in cold weather, cannot safe- 
 ly be placed suddenly in a very cold atmosphere, without great 
 and immediate risk. It is true, we may guard their bodies 
 against the influence of cold so effectually as to receive no in- 
 jury; but we cannot protect much more important parts, with the 
 same certainty — for their lungs must receive the cold air with- 
 in them ; and hence, the danger. 
 
 451. But the danger just alluded to, does not arise so much 
 from the immediate effects of cold air upon these organs, as from 
 the subsequent action of the warm air, in which they must ne- 
 cessarily sooner or later be placed. Violent reaction soon fol- 
 lows the state of torpor, which the cold air imposed upon the 
 lungs ; and inflammation, catarrh, or cough, will almost cer- 
 tainly be the result. 
 
 452. A sudden attempt to " harden a child," as it is called, 
 in cold weather, is but another determination to see how much 
 a child can bear, without dying under the experiment. This 
 scheme, a scheme founded neither on reason, nor experience, 
 has had, to our certain knowledge, too many victims, for us not 
 to caution parents against the preposterous and dangerous prac- 
 tice. 
 
 453. We would ask, what has given rise to so decided a pre- 
 ference in favour of the system of exposure ? This question 
 would be difficult to answer, upon rational principles, or correct 
 observation. It has proceeded, without doubt, from some com- 
 mon fact relating to the effects of cold ; as the general bracing 
 power of a pretty low temperature- upon the body; but without 
 
 • Nor should their eyes be exposed to sudden and strong light. We have fre- 
 quently seen severe inflammation of these parts follow such incautious conduct. 
 
 18 
 
138 OF TEMPERATURE. 
 
 taking into view the various circumstances which were essential 
 to its favourable operation ; for instance, with the mercury down 
 to 10° of Fahrenheit, let two men, (every circumstance being 
 equal, but that of clothing,) engaged in such an atmosphere, at 
 any kind of active employment for a certain number of hours ; 
 the one to be sufficiently clad to prevent, when at rest, any very 
 great inconvenience from the cold ; and the other, not so well 
 protected I the latter, in this case, would require additional ex- 
 ercise, to prevent suffering* At the expiration of the assigned 
 period, what would be the respective situations of these men ? 
 The one would be found to have performed his task without 
 difficulty, or much fatigue; the other would be seen to have 
 performed either less work, or be more exhausted ; for, in order 
 to do the same quantity of work as his Companion, he would 
 have to labour much harder, to keep up the same degree of ani- 
 mal heat ; or he will have performed less, and have suffered 
 more from' the benumbing effects of cold. This is found to be 
 the case also with animals, especially horses. Where, then, is 
 the advantage of this sudden attempt at bracing by cold ? Be- 
 sides, as regards the human constitution, and especially that of 
 children, it is agreeable to the observations of all medical men, 
 that those children who are properly and sufficiently clad, are 
 freer from disease, than those injudiciously exposed for the pur- 
 pose of hardening them,* 1 
 
 454^ But it is, also, undoubtedly true* that those who may 
 have survived the ordeal of ill-conducted winter exposures, are 
 generally best confirmed in their after health ; but this only proves 
 the strength of original constitution, since it stood the severe 
 tests to which it had been exposed ; but we are not informed of 
 the fifty-fold failures of the experiments Let us apply this rea- 
 soning to the effects of extreme heat upon the constitution, and 
 see how ill the analogy, though correct, will support the practice 
 of " hardening," or how few would be willing to have recourse 
 to the trial. It is a matter, notorious to every one, that the 
 emigrants to the West India islands, or other hot climates, who 
 
 * It is here recommended not to mistake the meaning of this caution, and 
 err On the contrary side: we do not mean to advise a direct contrary course; for we 
 are aware that many have fallen into this error, loading- their children with un- 
 necessary clothing and absolutely keeping them sweating upon the least exercise, 
 by an over cautious mode of sending them abroad. The children are then ex- 
 posed to all the effects of cold air, on a moist skin. 
 
OF TEMPERATURE. 139 
 
 survive the " seasoning," enjoy, for the most part, the best pos- 
 sible health ; and perhaps, these places will furnish as many in- 
 stances of longevity, as almost any other parts of the world ; but 
 would any one give these instances as proofs of the healthiness of 
 an exposure to a tropical sun, or as a means to acquire long 
 life ? Would not any one, to whom such a proposition were 
 made, directly declare, that the great number of victims, to the 
 few instances of success, are entirely concealed ? 
 
 455. It would seem to be a point acknowledged by all writers 
 upon the treatment of children, that extensive and deadly effects 
 are constantly witnessed, from the variability of climate, and 
 from unnecessary, or from unavoidable exposure in cold weather. 
 The great increase of acute, as well as of chronic affections 
 during the winter, would seem to confirm this impression. In 
 our mutable climate, the consequences of unavoidable exposure 
 of the children of the poor to its inclemencies, are familiar to 
 the observation of every one who may have felt an interest in 
 the claims of humanity; and so far as we can collect from these 
 observations, the opinion appears to be concurrent, that much 
 suffering, great increase of disease, and an augmented mortality, 
 are the constant results. Let us then hear no more of the argu- 
 ments derived from this class of people, in support of the unsta- 
 ble hypothesis, that the health of the children of the poor is a 
 proof of the advantage of exposure to harden the body against 
 cold, or to confirm the system against disease. 
 
 456. We are aware, that instances of the entire success of 
 this plan, may be quoted against us: thus, that Mrs. A, B, C, 
 &c, accustomed their children to such exposure; and it will 
 be triumphantly asked, " Where can you ^find finer, or more 
 healthy children?" But we would ask, in our turn, do they at 
 the same time furnish us with an equally faithful list of those, 
 who have died from the experiment 1 If they could, the argu- 
 ment w r ould not be urged a second time, 
 
 457. The occasional success of a hazardous experiment, is 
 very often productive of the most serious evils ; it is followed as 
 an example, when it should have been regarded but as an excep- 
 tion ; nor is the error corrected, but at the expense oftentimes 
 of many lives. Thus, for the supposed cure of an obstinate dis- 
 ease by an ignorant quack, the patient, grateful for his recovery, 
 attributes to the skill of his attendant, and the virtue of his re- 
 medies, what justly belongs to the strength of his own consti- 
 
140 OF FASHION, 
 
 tution, or the favourable efforts of nature ; and if they fail'a 
 hundred times in other instances, the disappointments are con- 
 cealed ; for each is ashamed to declare, he had reposed confi- 
 dence in the remedies — therefore the supposed success is alone 
 heard of. 
 
 Sect. II. — Of Fashion. 
 
 458. Fashion has also exerted a baleful influence over the 
 best feelings of the mother, for she has become willing to sa- 
 crifice the health and well-being of her offspring to its shrine. 
 
 The preposterous, and unsightly exposure of the arms of chil- 
 dren cannot be too loudly reprehended, since it has neither con- 
 venience nor beauty to recommend it : yet it is attended by the 
 most serious, and manifest injury to the child. This practice 
 may be perpetuated, from an ignorance of its dangerous tenden- 
 cy, and from a desire to give to the body an increase of power, 
 to resist cold. We have in several places condemned the system 
 of hardening ; rather from the manner in which it is attempted, 
 than from its want of utility, if properly conducted. In order, 
 however, to render any plan effective, a knowledge of certain 
 anatomical and physiological .facts is essential ; and we shall 
 accordingly expose them as opportunity may present itself, in 
 the best manner we can. But upon no occasion, perhaps, shall 
 we so satisfactorily have it in our power to show the injurious 
 effects of cold upon the chest and lungs, as in the custom we 
 are now attempting to destroy. The cautions suggested by the 
 exposition we shall give, will be the more valuable, as they 
 will strike the common sense of every body ; and they will be 
 the better appreciated, as the facts are the result of anatomical 
 investigation, and not deductions of preconceived theory. 
 
 459. Portal, in a memoir inserted in "La Medicine Eclaree," 
 p. 335, shows, with much clearness, the connexion between the 
 lungs and the superior extremities, by means of a great quantity 
 of spongy cellular membrane, which proceeds from the upper 
 parts of these organs ; which, after passing under the clavicles,* 
 and accompanying the axillary vessels and nerves,t penetrates 
 the glands of the arm-pits. The spaces between the scapulaj 
 and the upper ribs, are occupied by this tissue ; so, also, is the 
 space between the great pectoral and dorsal muscles,§ under 
 
 * Collar bones. \ Vessels and nerves of the arm-pits. 
 
 * Shoulder blades, and neck. § Muscles of the breast and back. 
 
OF EXPOSURE AND HARDENING. 141 
 
 which it passes ; and extends itself to other muscles of the back, 
 and those of the breast. The free and prompt communication 
 between the lungs and upper extremities, is proved, M. Portal 
 informs us, by injections. And nature may, in part, be imitated 
 by the anatomist ; for if he inject water into the cellular tissue 
 of the lungs, it will be found to pass from air cell to air cell, 
 until it arrive at the external part of the breast, and under the 
 arm-pit ; from whence it spreads itself to the arms and lateral 
 parts of the chest, by means of the tissue just spoken of. M. 
 Portal declares, he has reversed this experiment, by making wa- 
 ter, or air, pass from the arms, or arm-pits, to the air cells of the 
 lungs. From these facts the deductions are clear — namely, that 
 whatever does injury to the upper parts of the arms, or arm- 
 pits, will be felt by the lungs, &c. ; hence the injury which must 
 necessarily arise from the-exposure of these parts to cold, &c. ; 
 and hence, in a practical point of view, the importance of reme- 
 dial means to these parts, in cases of disease of the lungs ; and 
 hence, in children born of consumptive parents, the necessity 
 and importance of having them sufficiently protected from cold 
 by suitable covering. 
 
 Sect. III. — Of Exposure and " Hardening." 
 
 460. In our valuable climate, we oftentimes have every va- 
 riety of the year, in any one given portion of it ; thus, in the 
 middle of our winter, we have sometimes the mutability of April, 
 or the mildness of May. If the latter be the case, or the tem- 
 perature even lower, it w'ould be folly to deny the enjoyment, 
 and advantages of fresh air, (the body being properly guarded,) 
 because our almanack declares the month to be January. The 
 rule, then, for taking children into the open air, either in sum- 
 mer or in winter, must be founded in some measure upon our 
 sensations, and the thermometer ; for in summer, this instru- 
 ment may indicate too high a temperature; and, in winter, one 
 too low, for the purposes of exercise or of exposure. 
 
 46L But w 7 hy should it be thought impossible to have fresh 
 air in winter, unless the child be exposed to the inclemency of 
 an out-door atmosphere ? At that season of the year, is not the 
 air, in a well-constructed house, of equal purity with that abroad? 
 Cannot the temperature of a room be so regulated as to do away 
 
142 OF EXPOSURE AND HARDENING. 
 
 all risk in the enjoyment of the air ? And is that air not suffi- 
 ciently pure and elastic for all the purposes of health ? If these 
 questions be answered in the affirmative, and we are sure every 
 rational person will answer them so, we are in possession of a 
 safe and certain means to give the child fresh air, without the 
 serious risk of exposure. 
 
 462. Let us, however, admit to the sticklers for exposure, 
 there might be an advantage in " giving the child fresh air in 
 cold weather," agreeably to their opinions of fresh air, will it 
 not be conceded, on the other hand, that it will require much 
 care? Will it not require that the child's body, or other parts, 
 should not be exposed, but carefully, and sufficiently protected? 
 Will it not also be admitted, that if attention be not paid to these 
 circumstances, much risk, if not positive danger, will be in- 
 curred ? If these points be yielded, we will ask, if one mother 
 in a hundred be so fortunate as to have a person to take the 
 child " abroad," in which this essential confidence should be 
 placed ? We are sure that many, perhaps, very many, will say, 
 Yes ! because they believe so : yet any one of observation who 
 traverses our city, may contradict them; for they may constant- 
 ly witness the limbs of the little sufferers exposed until purple 
 with cold, while the nurse is attentive alone to her own plea- 
 sures or amusements, or holding a long gossiping colloquy with 
 a dear friend, whom she has not seen for the " age of a week/ 9 or 
 in examining in detail all the attractions of a print-shop, or feast- 
 ing her imagination with the delightful articles of a pastry 
 cook's window. After this, the child is brought home, benumbed 
 with cold ; the mother receives it with rapture, and because her 
 darling has been breathing an air but little above Zero for se- 
 veral long hours, anticipates future health for her child ; at the 
 moment, perhaps, it has received its death-wound. 
 
 463. It may, perhaps, be urged in opposition to these opinions, 
 that the children of poor people are constantly " exposed," and 
 have, in consequence, the best possible health. But upon this 
 point, let the whole truth be told : we admit that " the children 
 of poor people are exposed ;" and also agree, that the number 
 which remain of a family may even have " the best possible 
 health ;" but we would ask at what expense has this " best possi^ 
 ble health" been procured? Look at our bills of mortality, and see 
 how large a proportion of the deaths is made up of young Chi!-- 
 
OF EXPOSURE AND HARDENING. 143 
 
 dren ; and then examine the returns at the Health Office, and 
 you will find how many of these " exposed" little sufferers have 
 died by the experiment, or, rather, perhaps, from the unavoida- 
 ble " exposure." 
 
 464. Many children, and especially those in large manufac- 
 turing towns ; those of poor people, in crowded situations, and 
 those who have but a scanty supply of provisions, are born with 
 a strong predisposition to diseases. In severe weather, they are 
 exposed to the debilitating effects of cold, besides the evils just 
 mentioned, by which the latent dispositions are converted into 
 active diseases ; and these victims swell very much the bills of 
 mortality. 
 
 465. Cold, when combined with poverty, exerts an almost 
 irresistible influence upon the human constitution ; they destroy 
 and spare not the helpless infant exposed to their violence ; they 
 desolate without stint or measure, and have more victims than 
 any one disease in the whole catalogue of human maladies. 
 
 466. Adam Smith confirms this, when he says, " It is not un- 
 common, I have frequently been informed, in the highlands of 
 Scotland, for a mother who has borne twenty children, not to 
 have two alive. Several officers of great experience have told 
 me, that, so far from recruiting their regiment, they have never 
 been able to supply it with drums and fifes, from all the sol- 
 diers' children that were born in it." # 
 
 467. In thus attempting to point out the impropriety and dan- 
 ger of ill-regulated, or indiscriminate " exposure," let us not be 
 supposed to favour the opposite extreme — than which nothing 
 can be farther from our views. We as earnestly deprecate an 
 overweening caution, as we condemn unnecessary exposure; the 
 mean is the golden rule ; and the degree of temperature, regu- 
 lated by the force of constitution. It would be no less prepos- 
 terous than injurious, to subject every child to an equal degree 
 of exposure. The strength of constitution varies in almost 
 every individual — cold air is, unquestionably, a cold bath with 
 certain modifications; now, no one would declare that the cold 
 bath, and, especially, one of the same temperature, would be pro- 
 per to every constitution, or at all times to the same constitution. 
 
 468. We agree that children may be brought up too tenderly : 
 
 * Wealth of Nations, vol. I. p. 105. 
 
144 OF EXPOSURE ANO HARDENING. 
 
 and we declare this mode to be as wrong as the other — because, 
 like it, it has its victims. Extremes, therefore, are never right. 
 Upon a subject like the present, it would be impossible to lay 
 down precise rules for every variety of case — we, therefore, can 
 only give general directions upon this subject; the deviations 
 which particular instances may require must be left very much 
 to the good sense and discretion of the parent. We must re- 
 mark, however, 1st, that the lungs of young children cannot bear 
 as low a temperature, with safety, as children of more advanced 
 age, nor those of even a more advanced age, so low a tempera- 
 ture as an adult; 2dly, that the injury which young children 
 receive when exposed to a very low temperature, is through the 
 medium of the lungs, and is not of a direct kind ; for it generally 
 requires the sudden application of warmth to call into action the 
 injurious effects of the previous cold — therefore, this important 
 caution suggests itself, in the management of children who have 
 been unavoidably or necessarily exposed to a low tempera- 
 ture — viz. not to bring them too suddenly into an atmosphere of 
 high temperature ; 3dly, as it is, the lungs, which especially suf- 
 fer from a low temperature, no precaution of covering the body 
 can protect them with certainty against the consequences of such 
 exposure ; yet, if the body be well protected, it will very much 
 diminish the chance of injury to the lungs, by tending to maintain 
 and equalise excitement ; 4thly, but if both lungs and body be 
 exposed, the system has then to contend against the depression 
 consequent upon the exposure of a large surface of skin, as well 
 as that of the lungs ; therefore, the risk of injury is increased from 
 this circumstance. 
 
 469. We once urged the above"and similar objections against 
 indiscriminate " exposure," to a lady who was a great stickler 
 for it, when we were told, with an air of triumph, that the plan 
 she had adopted in sending out her children, would at once be 
 an answer to all our objections to the practice. The plan, which 
 shall be told in her own words, was as follows : — " When the 
 weather is cold, and that is the time you principally object to 
 a child being carried out, I take care not only to clothe the child 
 very well, but, also, before the nurse sets out, to cover its little 
 head completely with a good warm cloak, so that the cold air 
 cannot get to its mouth; and it will sleep, when it is thus covered 
 up, as soundly as if it were in its cradle in the nursery. So you 
 
 *L- 
 
OF EXPOSURE AND HARDENING. 145 
 
 see that no possible injury can happen to the child, since it is 
 not made to breathe the cold air, which you appear so much to 
 dread." 
 
 470. We admitted this completely prevented the child from 
 breathing the cold air ; but it unfortunately created an objection 
 nearly, if not altogether as strong, as the one it was intended to 
 remove — namely, that it obliged the child to breathe a heated and 
 impure air, generated by its own lungs ; consequently, the pre- 
 text for sending the child abroad, was entirely done away. We 
 asked this lady, how she would like the plan of placing a child,- 
 on a very cold day, in the yard, after carefully wrapping it up 
 in its "crib," that it might enjoy a nap in the open air ? This 
 she declared would be highly dangerous, and she could never 
 think of running such a risk. We then asked her in what this 
 plan differed from her own 1 She became much puzzled for an 
 answer, and could only defend it, by saying, that according to 
 her method, the child had the advantage of exercise, which the 
 other had not. We then appealed to her candour, and asked if 
 the child were more passive in the crib, than while sleeping in 
 the nurse's arms ? 
 
 471 . At another time, we were speaking with a lady who had 
 lost three or four children with " croup," wfod informed us, she 
 was convinced from absolute experiment, there w^as nothing like 
 exposure to all kinds of weather, to protect and harden the sys- 
 tem. By her first plan of managing her children, which was 
 by keeping them very warmly clad, she lost several by the 
 " croup," but since she had adopted the opposite scheme, her 
 children had been perfectly healthy, and never had betrayed the 
 slightest disposition to the terrible disease which had robbed her 
 of her other children. 
 
 472. " Perhaps, madam," we observed, " you did not, in 
 making your first experiments, attend to a number of details, 
 which might be thought essential to the plan — you probably did 
 not take the proper precautions when you sent them into the 
 cold air, or observed what was important when they returned 
 from it." " Oh ! yes, I took every possible care : when they were 
 going out, I always made them wear a very warm great coat, 
 well lined with baize, and a fur cap, or collar; I always made 
 them wear a ' comfortable,' made of soft woollen yarn, round; 
 their necks: and their feet were always protected bv socks or 
 
146 OF EXPOSURE AND HARDENING. 
 
 over-shoes, lined with fur or wool, as the weather might be wet 
 or dry." 
 
 473. " Do you believe, madam, they were kept at a proper 
 degree of warmth by these means V\ Oh ! certainly : indeed, 
 rather too warm ; for they would often be in a state of perspira- 
 tion, they told me, when in the open air, especially when they 
 ran, slid, or skaited." " And what was done when they were 
 thus heated ?" " Oh ! they got cool enough before they would 
 get home." " And would they receive no injury in passing from 
 this state of perspiration to that of chill ? " Not at all ; for 
 when this happened, I always made them take a little warm 
 "brandy, or wine and water, and made them ' toast f their feet 
 well by the fire."* " Did they sleep in a cold or warm room?" 
 " In a warm room : a good fire was always made in the stove be- 
 fore they went to bed, which kept them quite warm all night." 
 " Would they never complain of being cold towards morning, 
 when the stove had become cold V " Yes, certainly ; but then 
 there were always additional bed clothes at hand, with which 
 they could cover themselves." " And did they always do so?" 
 " Oh ! I suppose so." 
 
 474. " Well, madam, how do you. carry your second plan, 
 into execution, which you say was attended with such happy 
 results ?" " I began by not letting them put on their great coats, 
 but when the weather was so cold as to require this additional 
 covering, and did not permit them to wear a ' comfortable ' or 
 fur, round their necks. I took away their over-shoes ; and if 
 their feet chanced to get wet, (for they were always provided 
 with good sound shoes,) the shoes were immediately changed, if 
 they were at home. If the weather was wet, or unusually cold, 
 they were permitted to wear their great coats ; but not without. 
 If they came home very cold, they were not allowed to approach 
 the fire too soon. I gave them no warm, heating drinks, and 
 accustomed them to sleep in rooms without fire. 
 
 •475. Who does not recognise in this second plan for the en- 
 joyment of " air and exercise," as judicious a plan of " physical 
 education," so far as it goes, as can be w T ell pointed out ? — one 
 we have been endeavouring to recommend, instead of the one it 
 
 * This absurd custom is a fruitful source of that distressing' condition of the 
 iuperior and inferior extremities, in winter, called "chilblains.'' 
 
OF EXPOSURE AND HARDENING. 147 
 
 purported to be, " the happy results of indiscriminate exposure, 
 in all kinds of weather, to harden the system ; and in the first, 
 a preposterous routine of mischievous observances; observances 
 entirely calculated to defeat the object for which. they were so 
 anxiously instituted. We were so successful as to convince 
 this lady, in a very short time, that our " moderate plan " of 
 exposing the body, was precisely the one she had pursued with 
 so much success. 
 
 476. We also inquired of this lady, what plan she pursued 
 with her children, when too young to be subjected to the rules 
 just mentioned ? She informed us, it was the same system 
 throughout, only the details varied, accordingly as the circum- 
 stances of age, &c, made it necessary — that is, she sent her 
 children into the open air at very early periods of their lives, 
 provided in summer it was neither too wet, nor too warm; in 
 winter, when the air was mild, dry, and clear; but always care- 
 fully wrapped up, that their little extremities might not suffer 
 from cold. That she never suffered them to sleep in the open 
 air, if it could be avoided; to prevent which, as much as possi- 
 ble, she constantly charged the nurse to bring the children home, 
 as soon as she found them disposed to sleep, unless it was when 
 the children were very young, at which time it was impossible 
 to guard against it. 
 
 477. And, when her children were sufficiently old to walk, 
 she took care to provide them properly for it, whether it might 
 be in warm, cold, or moderate weather. That she never sent 
 them abroad for pleasure, at the risk of encountering a storm of 
 any kind ; nor permitted them to walk, at the hazard of getting 
 wet, or very muddy feet. " Were the constitutions of your 
 children pretty much the same?'' we demanded of this lady. 
 *-No: one of my boys was extremely feeble, from his very birth." 
 " Did you treat him after the same manner precisely as- you did 
 the others V u Yes, as far as regarded principles — that is, I 
 permitted him to bear as much of cold, heat, or wet, as his con- 
 stitution would support without pain, or injury; but the degrees 
 were very different from those his brothers bore, had they been 
 determined by the measurement of the thermometer, but pre- 
 cisely the same in effect, as far as could be ascertained by con- 
 sequences — thus, if he were exposed to the same temperature as 
 his brothers, he experienced no more inconveniences from it 
 
148 OF EXPOSURE AND HARDENING. 
 
 when it was very low, than they, because he had additional 
 covering to protect him, &c." 
 
 478. Let us not, however, be considered as advocates for a 
 warm and enervating plan of education, because we condemn 
 its opposite ; for we believe nothing contributes with more cer- 
 tainty to impair stamina, than too great a delicacy of treatment, 
 especially in the early part of childhood : and much as we de- 
 precate ill-judged exposure, we are inclined to believe it is 
 scarcely more injurious, than over-stimulating the tender sys- 
 tems of infants, by means of injudiciously applied heat. Heat, 
 beyond a certain degree, or when too long continued even in an 
 inferior degree, acts like any other stimulus upon the vibritile 
 system of very young children. It over-stimulates the nervous, 
 goads to excessive action the circulatory, and relaxes the mus- 
 cular systems. In consequence of this, the different parts of the 
 body do not develope themselves in their most healthy order, or 
 in their natural proportions— the whole body is urged to a pre- 
 cocious expansion. 
 
 479. The cuticular system also suffers from this ill-managed 
 application of heat ; on the external surface, the sensible perspi- 
 ration is greatly increased, and too long maintained ; by which 
 means the sensibility of the skin becomes too much exalted, and 
 cannot bear without immediate inconvenience, a lower tempera- 
 ture than that, to which it has been for a long time accustomed; 
 hence, as soon as this part is exposed, there is an immediate 
 check given to perspiration, by the capillaries terminating on 
 the surface contracting themselves — disease is, of course, the 
 consequence. 
 
 480. It is not the external membranous system alone that suf- 
 fers — the whole internal arrangement of it is more or less af- 
 fected ; for they either act inordinately, and produce affections 
 of the bowels, or lungs; or they become torpid; and in this way, 
 invite disease, by the destruction, or too great a diminution, of 
 certain important secretions. 
 
 481. Children over-tenderly brought up, either by heaping 
 upon them too much clothing, or prohibiting a sufficient exercise 
 in the open air, become liable to catarrhal affections, the instant 
 " the winds of heaven a little too rudely visit them ;" and this 
 misfortune is instantly quoted, against a proposal for a more in- 
 vigorating plan of treatment. Tims, the effects of an improper 
 
OF EXPOSURE AND HARDENING. 149 
 
 system of education, are mistaken for a natural weakness of 
 constitution ; in consequence of which, the error is perpetuated, 
 and the poor child becomes an early victim to a ferocious dis- 
 ease, or is made to drag out a protracted existence, in which 
 there is neither comfort nor enjoyment. 
 
 482. Such a plan of education is sure to entail imbecility of 
 mind, as well as debility of body upon its followers ; for every 
 part is put not only too extensively, but too early upon the 
 stretch ; in consequence of which no organ is duly prepared for 
 its offices ; ajid of course must perform its functions imperfectly. 
 This hot-house plan of rearing children, has ever had more vic- 
 tims than triumphs. It should, therefore, never be adopted, as 
 it is contrary to the dictates of -reason, as well as to the results 
 of experience — and truly, like the" hot-house plant, properly so 
 called, is forced beyond its powers, and prematurely dies. 
 
 483. One of the most remarkable instances of precocious ma- 
 turity, is that related of Louis II. King of Hungary. He was 
 born so much before his time as to have no skin.* . At two years 
 old, he was crowned ; in his tenth, he succeeded ; in his four- 
 teenth, he had a complete beard ; he married in his fifteenth ; 
 he had gray hairs in bis eighteenth, and in his twentieth, died. 
 
 484. But, though we unhesitatingly condemn the plan of edu- 
 cation just spoken of, yet are we at a loss to understand, why 
 it should be considered so desirable to inure the body to ex- 
 treme cold, in a climate like ours ; since the attempt must, in 
 part, be defeated, by every returning summer ; and more espe- 
 cially, as the experiment is often of great price, from the manner 
 in which it is too often conducted, by those w T ho call themselves 
 the exact followers of nature. In climates where cold is in the 
 extreme, nature attempts to guard against its evils, by esta- 
 blished laws, and not by occasional or desultory experiment. 
 In the very high latitudes, the inhabitants are enabled to sup- 
 port the low temperature to which they are exposed, by a phy- 
 sical conformation peculiar to such climates — thus, they are al- 
 most invariably short of stature, fat, and enormous eaters of 
 the most stimulating food. 
 
 * This only means, we presume, that this covering to the body was exces- 
 sively delicate, as we always witness when the foetus has not reached the seventh 
 month. 
 
150 OF FOOD. 
 
 485. Their short stature enables the heart to drive the blood 
 with more force and certainty to the extremities ; and these are 
 the parts most likely to suffer; for it is almost invariably found, 
 even in our comparatively warm climate, that tall people suffer 
 more than short, from cold. And, hence it is, that the face col- 
 lectively, is enabled to support cold better than the hands, or 
 feet, as it is nearer the source of circulation ; and not because 
 it is more accustomed to cold from exposure : for certain parts 
 of it, (if we may so unite them,) as the ears, and the extremity 
 of the nose, in which the circulation is more languid, suffer 
 equally with the more remote parts of the body. The fat of 
 people of high latitudes also tends to the same advantage ; it is 
 a bad conductor of heat, and thus serves to prevent its escape 
 when generated within the system ; while their rapid digestion 
 of the most stimulating substances, favours the extrication of 
 caloric. 
 
 486. Both reason and experience, then, seem to caution us 
 against adopting with too much rigour, a system which is by 
 far too general in its principles, for useful or healthful applica- 
 tion ; but they at the same time direct us to conform to one, 
 which shall permit departures, whenever such departures shall 
 be warranted by a change of circumstance, or rational expe- 
 diency. And, hence, we may conclude, that there can be no- 
 thing more dangerous, than the random application of princi- 
 ples that are, in themselves, doubtful. 
 
 CHAPTER III. 
 
 OF FOOD. 
 
 487. The necessity of food commences after the first few 
 hours of a child's birth; hence, the early provision that is 
 made by the mother'^ breasts. Of this we have already spoken 
 at some length, and laid down some important general rules, 
 which we do not think necessary to repeat here. When we were 
 upon this subject, we considered the mother as the only proper 
 provider for the child ; and we decided that it was her duty, and 
 hers alone, to provide it nourishment from her own bosom ; and, 
 
OF FOOD. 151 
 
 the more effectually to ensure this under the best circumstances, 
 we recommended the early application of the child to the breast, 
 and gave our reasons for these directions. In addition, how- 
 ever, to what we then said, we shall give some other important 
 reasons for such advice. 
 
 488. In the last paragraph, we have in a very positive man- 
 ner declared it to be the duty of the mother, and of the mother 
 alone, to provide sustenance for the child, and that from her own 
 bosom — this is our decided and unalterable opinion, as a general 
 rule; a rule, that should not be heedlessly, or unnecessarily 
 broken ; one that should not be infringed, but from an imperious 
 necessity. No plea of inconvenience or trouble; nor the subter- 
 fuge of imagined ill health, either immediate or remote, should 
 be held valid. The incapacity, or incompatibility should be po- 
 sitive, ere the exception to the rule should be admitted ; never- 
 theless, disqualifications may, and really do exist sometimes, as 
 we shall now attempt to show. 
 
 Sect. I. — Causes which may render it improper for the Mother to 
 
 nurse. 
 
 489. The 1st is, where there is no provision made for nou- 
 rishing of the child; or where this is not in sufficient quantity, 
 either owing to a natural, or accidental derangement of the 
 breasts, or the imperfect performance of their duty. 
 
 490. 2dly, Where the supply may be sufficiently abundant in 
 the commencement, but where it habitually fails in a short pe- 
 riod after, owing to some constitutional or accidental defect, 
 which, perhaps, is neither evident, nor remediable. 
 
 49 i . 3dly, Where, upon former occasions, it was unquestion- 
 ably found to disagree with the child.* 
 
 492. 4thly, Where there is a strong venereal or scrofulous 
 taint in the constitution of the mother. 
 
 493. 5thly, Where suckling produces an active or painful dis- 
 ease in the mother, as cough, colic, &c, and also, as 
 
 * We must not, however, take this rale without exception — we have seen two 
 instances within the last few years, where the mothers upon former occasions 
 were obliged at an early period to abandon suckling-, owing to the bad qualities 
 of their milk; but upon the occasions now spoken of, it was not only very abun- 
 dant, but of most excellent quality. The children, in both these instances, were 
 of uncommon health and vigour. 
 
152 OF FOOD. 
 
 494. 6thly, Dr. Struve says, « Those mothers who are so un- 
 fortunately situated that they cannot avoid provocation, grief, 
 or sorrow ; as well as others, who possess an irascible, and bi- 
 lious temperament, or are subject to great nervous debility, ac- 
 companied by great susceptibility of every stimulus, will confer 
 no benefits on their children by presenting thern with a corrupt- 
 ed milk, Which cannot fail to injure their health, and lay the 
 foundation for consumptive and fatal maladies."* It must not,- 
 however, be imagined, that we intend to convey the idea by this 
 quotation, that the milk itself contains the rudiments, or seeds 
 of the diseases just mentioned, but merely, that constitutions la- 
 bouring under such infirmities, cannot furnish healthy milk; or 
 that of a- sufficiently nutritive quality; and in consequence of 
 the child being imperfectly nourished, its constitution yields to 
 its predispositions, and active disease is produced. 
 
 495. Parents labouring under certain chronic affections, may 
 transmit to their offspring predispositions to such diseases ; and 
 the body so predisposed, if it be not properly nourished in its 
 very early infancy, whereby it may become strong and well de- 
 veloped, the constitutional tendency may be called into action, 
 and the child die early, or have a protracted disease as its con- 
 sequence. These cases are daily presenting themselves to the 
 physician, for his contemplation; and they have long and anx- 
 iously engaged his most serious consideration; the result of 
 which, so far as experience has yet determined, is, that nothing 
 gives so effectual a check to this tendency, as bringing up the 
 child upon a healthy breast of milk. 
 
 496. Therefore, when either of these conditions of the parent 
 obtain, either in the shape of infirmity of temper, or of actual 
 disease, it is certainly proper to provide the child with some 
 other means of support, but the precise mode must be deter- 
 mined by circumstances ; the best for such cases as the fourth, 
 (492) and the sixth, (494) is a healthy wet nurse, especially in 
 the country. 
 
 * Treatise on Physical Education, p. 215. 
 
OF THK MECONIUM. 153 
 
 CHAPTER IV. 
 
 OF THE MECONIUM, AND ITS MANAGEMENT. 
 
 497. During pregnancy, there is an accumulation of a dark 
 green substance in the bowels of the child, which is called " me- 
 conium," from its supposed resemblance to the sirup of poppies. 
 This substance contains some bile;* it is in various quantities ; it 
 is of different tones of colour, and of degrees of tenacity; and 
 when permitted to remain undisturbed in the bowels of the child, 
 is productive oftentimes of much mischief, especially in hot cli- 
 mates. This being the fact, it now seems to be admitted by all 
 who are conversant with this subject, that it should be purged 
 off as early as circumstances will permit. It is only wonderful 
 that there should have been two- opinions upon this subject; 
 since nature, if properly followed, performs this office by her own- 
 means, without the interposition of art. She effects this import- 
 ant end by means of a substance found in the mother's breasts, 
 upon the first application of the child to them, called colostrum. 
 
 498. But to derive advantage from this natural purgative, the 
 child, as we have before remarked, must be applied early to the 
 breast ; if this be neglected until the secretion of milk, properly 
 so called, take place, it becomes too much diluted to serve this 
 important end, and we are then under the necessity of having 
 recourse to artificial purgatives, which never remove this sub- 
 stance so kindly as the colostrum.^ Hence in consequence of 
 
 * The meconium is evidently excrementitious, as it only occupies the colon 
 and rectum; that it generally contains bile is every way certain; but not necessa- 
 rily, as, in some instances, bile has not been found in the duodenum of still-born' 
 children, that had arrived at full time, though meconium was present. 
 
 f It may be remarked, that those children who have been kept from the breast 
 for several of the first days after birth, because, as the ignorant nurse declares, 
 *• there is nothing for them to draw," are uniformly more difficult to "dea/ise*" 
 than those who have received into their stomachs the "colostrum " just spoken' 
 of. This substance, however, may be aided by the exhibition of a little molasses- 
 and water. 
 
 20 
 
154 OF THE MECONIUM. 
 
 this neglect, the child is often tortured by colic or spasm, from 
 the harsh remedy which may have been employed for this pur- 
 pose. 
 
 499. Purging off the meconium, is a matter of more impor- 
 tance than is generally supposed, as well as the manner of do- 
 ing it. The propriety of this measure is so universally acknow- 
 ledged in this country, that it has become a practice of routine 
 in the management of new-born children ; and in becoming so, it 
 is made a matter of too much indifference by what agent this is- 
 produced — hence, the improper employment of stimulating and 
 drastic purgatives upon such occasions, to the decided incon- 
 venience, if not ta the manifest injury of the child. This dis- 
 regard of the means by which the meconium is carried off, has 
 arisen sometimes from an over-importance being attached to 
 the consequences, should it be suffered to remain, or be found 
 difficult to remove. 
 
 500. Should this substance have been but imperfectly dis- 
 charged from the bowels, all the evils which may chance to as- 
 sail the child are attributed to this neglect — nurses, accordingly, 
 dreading such an accident, take care that no such blame shall 
 
 * attach to them; they, therefore, become indifferent to the means 
 for its removal, provided the end be answered. In consequence,: 
 harsh and ill-judged remedies are employed; and, sometimes, to< 
 the almost immediate destruction of the child. We are per- 
 suaded, from our own observations, that many instances of the 
 severe and sometimes fatal bowel complaints of very young chil- 
 dren, have arisen from another source ; and it, therefore, be- 
 comes an important part of our duty to inveigh against this 
 dangerous practice. 
 
 501. The evil we are now speaking of has principally arisem 
 from two sources — 1st, as has already been remarked, from an- 
 undue importance being attached to the retention of the meco- 
 nium; and, 2dly, from too unlimited a confidence being placed 
 in the judgment of the nurse. As regards the first, we hold it 
 highly proper, nay, perhaps, essential, that the meconium be 
 carried off; because nature herself declares its propriety; but it 
 by no means follows, that this must be effected, coule qui coute y 
 
 ■ — thh means should be properly adapted to the end; and-of these 
 we have a sufficient choice. For the purpose just suggested, a 
 solution of molasges, or of manna- in a little warm water; a tea- 
 
OF THE MECONIUM. 155 
 
 spoonful of sweet oil : the same quantity of the simple sirup of 
 rhubarb ; or, in more obstinate cases, a tea-spoonful of warm 
 •castor oil, is almost always sufficient. 
 
 502. It is true, that we occasionally meet with instances of 
 such tardiness of bowel, or so large a quantity of meconium, 
 that a repetition of the above named remedies may be necessary ; 
 but they should never be persevered in after the object for 
 which they were given has been answered ; and this is ascer- 
 tained with almost absolute certainty, by making ourselves ac- 
 quainted with the appearance of the evacuations — if they are 
 no longer tenacious, and of a dark green colour, the bowels 
 have been sufficiently purged, or, in other words, if the evacua- 
 tions have become yellow. 
 
 503. 2dly, Much mischief has been done by reposing too 
 much confidence in the judgment of the nurse. This always 
 convenient, and oftentimes highly valuable appendage to the 
 lying-in room, is too frequently self-willed, and will too often 
 run counter to the advice of the physician. This arises from 
 lier attaching too much consequence to her own experience; or 
 by having " the pride of office,' ' in her opinion too much humbled? 
 by an appeal from her decisions. To prevent her self-love be- 
 ing wounded by interference in her management, she very often 
 
 ^conceals from the physician in attendance, any casualty that 
 may befall the child: and thus important time is sometimes lost, 
 for the complaint may be serious, when the physician is first 
 made acquainted with it : whereas, had it been attended to w 7 ith 
 sufficient promptitude, it might have been of little moment: 
 here, by her want of knowledge of what was proper to be done, 
 and the application of improper remedies, the disease has been 
 permitted to acquire a force, that may bid defiance to future 
 ^attempted control. 
 
 504. We trust we have a just and due respect for this class of 
 people : and we are sure we are incapable of bringing any false 
 charges against them ; but a long experience has settled in our 
 minds their exact value. The estimate we have made of their 
 •worth, makes us declare that some are invaluable for their pa- 
 tient endurance of fatigue; for their occasionally successful exer- 
 cise of judgment; and for an amiable display of social virtues; 
 but others are the very reverse of what we have just declared. 
 
 505. During the attendance of the physician, the duty of a 
 nurse, as regards the medical treatment of both mother and child, 
 i- reduced to great simplicity — for she should but obey, and that 
 
156 OF THE MECONIUM. 
 
 implicitly, his directions. She should never violate his orders 
 herself, nor knowingly suffer others to do so ; but every thing 
 which belongs to medical treatment, whether it be merely pro- 
 phylactic; the absolute administration of medicine; or the ob- 
 servance of regimen, she should never interfere with ; on the 
 contrary, she should most scrupulously see them duly and rigo- 
 rously enforced ; for it is her bounden duty. During the period 
 of convalescence, she should constantly make her directions and 
 management conform to the general principles, inculcated by 
 the medical attendant. When she does more or less than this, 
 she does wrong, and ought to be made accountable for any 
 mischief that may happen. But we have, perhaps, no right to 
 expect any thing but the exercise of the blindest temerity, from 
 those whose opportunities do not afford intellectual culture. 
 
 506. Unfortunately, the custom of society is, in this particu- 
 lar, almost in direct opposition to what we esteem its best inte- 
 rests. The opinion of a nurse is oftentimes taken before that 
 of an experienced practitioner ! In this the world departs from 
 all its other habits. If advice be wanted on a question of law T , 
 will it prefer the opinion of the constable to that of the expe- 
 rienced advocate f If a text of scripture is wished to be ex- 
 pounded, will it apply to the church clerk, rather than to the 
 learned divine ? Or, should even a coat, or hat, or a pair of 
 shoes be wanted, will it prefer the efforts of the apprentice to 
 those of the master. 
 
 507. If this practice had not a decided influence upon the im- 
 mediate health, or the future welfare of the child, we should 
 not think it worth mentioning ; but when we have witnessed so 
 many serious errors committed at this period of the child's life, 
 we think it an* imperious duty to try to correct them. In 
 making these charges against this class of highly necessary 
 people, we disclaim all intention to criminate — we urge but an 
 error of judgment. But from the number of victims, as we 
 most conscientiously believe, this confidence in nurses has had, 
 it is full time a stop were put to their ravages : for, were we 
 to declare honestly, in round numbers, the instances of death 
 of very young children, which we believe we have witnessed 
 •ourselves, in consequence of the errors we are speaking of, we 
 should be afraid our truth might be questioned, and that we 
 should be suspected of indulging in hyperbole. 
 
 508. Nor will this statement excite much surprise, when the 
 
OF THE MECONIUM. 157 
 
 facts connected with it shall be investigated by rational and 
 dispassionate inquiry. Let it be remembered by what a ten- 
 der tenure, a new-born babe holds its ill-established life; let 
 it be recollected, how many causes may suddenly act, to wea- 
 ken that life, which is now so frail; let it be taken into view, 
 that if these causes be not successfully removed, they, for the 
 
 % most part, w T ill produce death; then let it be admitted, how 
 much judgment and experience are required, to detect the par- 
 ticular cause ; how much care and knowledge are essential to 
 the suiting of the strength of the remedy to the force of the dis- 
 ease ; and let it be acknowledged that if these do not' unite in 
 the person of the nurse, who now usurps the place of the phy- 
 sician, that much danger must be incurred, and we shall cease 
 to wonder, that their efforts, to say the least, are not crowned 
 
 •"by success. 
 
 509. It is our firm conviction, that the mortality among chil- 
 dren is unnecessarily great ; and that this excess originates, in 
 very many instances, in the mal-administrationof the means of 
 life, rather than to the operation of natural or inevitable causes,. 
 Some are nursed to death, w 7 hile many die because they are not 
 nursed at all; some are fed to death, while others die from inani- 
 tion ; some are physicked to death, while others die from the 
 want of a single dose of it — all of which go to prove how much 
 experience and judgment are required to administer with suc- 
 
 . cess, to the many wants and infirmities of children. 
 
 510. It must appear reasonable to every reflecting mind, that 
 the great mortality among children must have for its cause a 
 
 ' variety of circumstances, not absolutely essential ; and that it is 
 more than probable, that many of the contingencies to which 
 the poorer classes of children may be subjected, are of a na- 
 ture to be improved, if not to be removed altogether. It justly me- 
 rits the consideration of every friend to humanity, to ascertain 
 the causes which may produce this uncommon mortality, with 
 all the precision of which the subject may be susceptible. 
 « 511. To us short-sighted mortals, it would seem to be no part 
 of God's providence, to create so many children that they may 
 perish at so early a period of their existence. And we are firmly 
 persuaded, that the following are the principal means by which 
 this immense mortality of children may be diminished : — 1st, 
 Let none but a mother, when she is able, have the immediate 
 charge of her child ; for she alone should supply it with food; it 
 
I 
 158 OF THE MECONIUM. 
 
 is she alone who should administer its medicine. 2dly, Let 
 every mother make herself well acquainted with the best opinions 
 upon the physical management of children ; but never let her 
 aspire to their medical treatment, except from dire necessity. 
 3dly, Let no mother trust another to count out doses of laudanum, 
 while she herself retains the faculty to do so, unless the per- 
 son thus chosen has as deep or nearly as deep an interest in 
 the child as the mother herself* 4thly, in case of indisposition, 
 let the mother confide in no judgment for her child's disease, 
 but that of her physician, if his advice can be commanded; and,, 
 above all, let not his prescription be interfered with, by the obtru- 
 sive advice of a nurse, or still more ignorant old woman. 5thly, 
 Let a mother place no undue confidence in the prescriptions of 
 a nurse, under the persuasion 'that her experience must be valu- 
 able, when the advice of an experienced physician can be ob- , 
 tained; for let it be recollected, that if experience is to be the 
 
 * We have italicized th^is direction, because of its importance, and because 
 we wish it to be impressive; for we have every reason to believe that the* trusting 
 this important office to others, has been fatal in several interesting" cases, which 
 have fallen under our immediate observation, and, in several, we have had proof, 
 while in others, strong- suspicions were entertained, that the deaths were owing* 
 to the improper exhibition of laudanum. This drug has now become so familiar, 
 as to be ranked with the "domestic remedies;" its presence no longer excites 
 dread, nor its exhibition terror. But let it be remembered, that, however tjie 
 horror of the rattlesnake may be diminished by familiarity, its sting is no less 
 deadly. 
 
 We have every reason to believe, that thousands of children are sacrificed 
 yearly, by over-doses of this medicine. Its use is so common, and its virtues so 
 often witnessed, that caution sleeps — for even children are trusted with its ex- 
 hibition. A fatal instance of this kind has happened within our knowledge, not 
 long since. A fine little girl of nine years of age, complained to her mother of 
 the toothach— the mother told her to put some laudanum in it, and gave her a 
 vial of the liquid for this purpose. The child took a quantity of it into her mouth, 
 and held it there: but at the same time, swallowed enough to destroy her in a few 
 hours after. And we once heard a mother, who was about to leave home for 
 some hours, desire her daughter, a girl of eleven years of age, to give the baby 
 five drops of laudanum, should it be " cross" while she was gone! We remon- 
 strated with her upon this extreme carelessness, but we were answered, her 
 "daughter was used to it!" 
 
 It is still fresh within our recollection, when our prescriptions for laudanum 
 would frequently meet with opposition; and if the counting of it were trusted to 
 the "nurse," she would, perhaps, diminish the dose — but now! she gives it not 
 only with a free, but oftentimes with a daring hand. A laudanum bottle is now 
 a sine qua non to the furniture of a nurse's pocket. 
 
OF THE PROPER NOURISHMENT, &C. 159 
 
 guide, the latter sees a hundred patients, to one of the former. 
 If these simple rules be well observed, we are persuaded, they 
 will tend to abridge the mortality among children. 
 
 512. Let us also call to our recollection a truth, which we be- 
 lieve none will dispute — that, in general, children are born 
 healthy, and, with good stamina ; and with the exception of 
 purging off the meconium, they require no medicine. If this 
 become necessary, it is no infringement of the rule — it is but 
 the exception to it ; therefore, the vile and hurtful practice of 
 drugging young children, cannot be too much reprehended. 
 
 CHAPTER V. 
 
 OF THE PROPER NOURISHMENT FOR THE CHILD. 
 
 513. Nourishment, and this derived, if possible, from the mo- 
 ther, is all that a new-born-child requires ; and it does not hap- 
 pen once in a hundred times, that the mother is not in every 
 respect competent to this end ; especially if she have previously 
 discharged the duties of one, by paying a proper attention to 
 her health. It rarely happens that the child does not find more 
 than is absolutely necessary to its sustenance ! therefore, it were 
 preposterous to furnish it with more. 
 
 514. The reasons which are assigned, for giving the child 
 other nourishment than the mother's milk, may be divided into 
 the relative and the absolute. The relative are — 1st, the f^ar 
 of weakening the mother ; and, 2dly, convenience. The abso- 
 lute is, the mother not furnishing a sufficient quantity, or that of 
 proper quality. It is, therefore, said, first, that the child should 
 be fed to spare the mother. How spare the mother ? If she 
 furnish more than* the child can consume, or only as much, how 
 is the mother spared, by satisfying the child's appetite by other 
 means I The milk is secreted in the breasts, by taking so much 
 material from the general mass of blood ; and all the conse- 
 
1G0 of the rnorER nourishment. 
 
 quences, which can happen, by that deduction, are already ex- 
 perienced in its formation. Therefore, the woman is no more 
 weakened by the child's taking it from the breasts, than if it 
 remained in them to be absorbed from them ; or, in other words, 
 the woman will not be strengthened by permitting it to remain 
 undisturbed in- them . 
 
 515. 2dly, Convenience. It is said, the child should be fed 
 early, that it may become accustomed to it, in case the mother 
 should be- sick, or should zvish to go out, or to leave it upon any 
 occasion.- But we say, " Sufficient for the day is the evil there- 
 of" — and that the child should never be subjected to a certain 
 evil, to guard against a contingent one; for should the mother 
 be ill, and suffer a diminution of milk, the child can then be 
 taught to feed, as certainly when feeding may be useful, as when? 
 it is not required. Therefore, there is nothing gained by the 
 anticipation ; but there may be something lost. And, consi- 
 dered as a convenience, when the mother may wish to leave 
 her child, it is both a cruel, and unnecessary one — cruel, be- 
 cause it will tempt a gossiping mother to neglect her dependent 
 child ; and unnecessary, because a child that is governed by a 
 well regulated system of nursing, can never suffer by any pro- 
 per period of absence of the mother. 
 
 516. It should, however, be observed, that the child should not 
 be subjected to any laws of nursing, until it is six months old ; 
 for up to this period, it will be rarely necessary to establish a sys- 
 tem, as it will seldom- make unnecessary demands for nourish- 
 ment, unless a bad one have been pursued from the commence- 
 ment, by indulging, or rather attempting to quiet the child by 
 the breast, or by the still more improper plan of giving it pap ? 
 because it cries. If this system be pursued, much inconvenience 
 will result; for one of two things must happen: 1st, If the child 
 do not cry from absolute pain, a bad habit will be generated; 
 for the child will cry for the mere gratification of being nursed:, 
 this will not only create a great deal of trouble, but will be high- 
 ly injurious to the stomach itself, by occasioning it to be over- 
 loaded, and thus producing vomiting, purging, or colic ; or, 2dly,. 
 If the child cry from actual suffering, the food may not do any 
 possible good, or it may much increase the evil, by its being 
 given at an improper or unnecessary time. Therefore, before 
 this kjnd of indulgence is established, let the mother believe the/ 
 
OF THE PROPER NOURISHMENT FOR THE CHILD. 161 
 
 child may cry from other causes than hunger, especially if the 
 breast, or food have not appeased it — let her examine whether 
 a deranged, or ill-adjusted pin, may not create the pain : or 
 that its bowels may not be tormented by flatulency : in the one 
 case, it is evident that the feeding can do no good ; and in the 
 other, it may be mischievous. 
 
 517. We all know how easily the stomach may be made to 
 demand more food than is absolutely required — 1st, by the fre- 
 quent repetition of aliment, or 2dly, by its variety; therefore, 
 both of these causes must be avoided. The stomach, like every 
 other part, can, and unfortunately does, acquire habits, highly 
 injurious to itself — and that of demanding an unnecessary quan- 
 tity of aliment, is not one of the least. It should, therefore, be 
 constantly borne in mind, that it is not the quantity of food taken 
 into the stomach, that is available to the proper purposes of the 
 system ; but the quantity which can be digested, and converted 
 into nourishment, fit to be applied to such purposes. 
 
 518. After the child has attained the sixth month, some sys- 
 tem should be observed in all its little supplies, whether of 
 nursing, or receiving of food, of rest, of cleaning, or of exercise ; 
 and as life really consists but in the performance of a routine of 
 habits, it is a matter of much moment, that only such should be 
 established, as will most effectually serve the general and best 
 purposes of the system — therefore, all unnecessary, as well as 
 every improper one, should be avoided; consequently, the sooner 
 we begin, and the more regularly we adopt such as are proper, 
 the better. 
 
 519. On this account, as little variety in the food of the child- 
 should be permitted as possible ; for when many substances are 
 offered, the stomach will receive more than it can master ; pre- 
 cisely like the ad alt at a plentiful table, each new article be- 
 coming a fresh provocative to appetite ; and for this reason, 
 also, a little latitude should be given to the periods of sleeping 
 or feeding ; for though we distinctly perceive an advantage in 
 some established order for -these, yet this order should not be 
 rigidly established, to the moment; for when it is strictly ob- 
 served, the child will require both the one and the other from 
 habit, rather than from necessity. Therefore, this extreme re- 
 gularity must be avoided, as much inconvenience may other- 
 wise result^ to both mother and child. 
 
 21 
 
162 OF NURSING BY THE MOTHER, 
 
 CHAPTER VI. 
 
 OF PARTIAL, ARTIFICIAL NURSING. 
 
 520. The absolute reason for feeding the child, namely, the 4 
 mother not furnishing a sufficient, or a healthy supply, is the 
 only one which, should be considered as obligatory. Such cases,. 
 however, present a choice of means— -1st, where the mother 
 may continue to suckle her child, aided by artificial means : 
 2dly, where she is obliged to have recourse to artificial means 
 entirely ; odly, a wet nurse. 
 
 Sect. I. — First means; or where the Mother may continue to nurse 
 
 her Child. 
 
 521. We have always considered it best, when there is such a 
 reduction of the mother's milk, as but imperfectly to nourish 
 the child, to aid this scanty supply with the preparation we have 
 already noticed, (248,) consisting of cow's milk, water and su- 
 gar. This maybe administered to the child, in one of two 
 ways — 1st, by the spoon ; and, 2dly, by the bottle. We should^ 
 however, never recommend the first, if the second can be en- 
 forced; and for the following reasons: 1st, it is always less 
 cleanly, as the child's breast is almost always wetted in the at- 
 tempt ; 2dly, the child is always fed, lying down, and, conse- 
 quently, there is some risk of strangulation ; 3dly, the tempera- 
 ture of the fluid about to be administered, may be so high as to 
 do injury to the child's mouth and throat, by burning ; 4thly r 
 there is a constant temptation to improve the victuals, by the 
 addition of flour, &c. ; 5thly, by the food being previously made 
 to pass through the mouth of the nurse, before the child receives 
 it ; 6thly, by this method, the child loses the advantage of the ad- 
 mixture of its saliva with the food it is receiving. Therefore, we 
 consider the second plan to be the best, w T hen it can be adopted. 
 
 522. It may be asked, would we confine the child which is 
 in part artificially nourished, to the diet just mentioned, until 
 the period of weaning ? We would say. No — we would permit 
 the addition of barley water, of gum Arabic water, of rice wa- 
 
OF NURSING BY THE MOTHER. 163 
 
 ier, or a small portion of arrow root, after the fifth month,* in 
 x^ool weather, should there be a predilection in their favour ; 
 but, up to this period, and in hot weather, we believe the sim- 
 ple diet above mentioned, to be the most proper ; especially as 
 the stomach gets a habit, if we may so term it, of digesting ar- 
 ticles with ease by becoming familiar with them ; hence, the 
 propriety, and importance, of confining the child to the mother's 
 milk, whenever this is practicable. 
 
 523. Dr. Clarke very justly observes, that "nothing is more 
 absurd than the notion, that in early life children require a va- 
 riety of food : only one food is prepared by nature for them, 
 and it is too presumptuous to assume that the Creator of the 
 world, acted in error ; and that the ignorance of man is capable 
 to correct it, or make any improvement in his works,"f 
 
 524. The articles of food administered to the child by the ar- 
 tificial plan, should be as little varied as possible, for the reason 
 just stated, and also, because each article has its period for di- 
 gestion ; it will therefore follow, that some may be of such diffi- 
 cult solution, as to be productive of much mischief. Much care 
 is also required to preserve the artificial articles in a perfect state, 
 as we have already noticed ; and the directions given at that 
 time, should be strictly adhered to, that the stomach may re- 
 ceive nothing in an altered or partially decomposed state. Be- 
 sides, is it not folly to change that substance, which agrees per- 
 fectly well with the child ? 
 
 525. Indeed, nature has very emphatically declared, by the 
 organization of the infant, that her laws respecting food cannot 
 be transgressed without marked injury. The want of teeth, or 
 the means to masticate, and the feebleness of the powers of di- 
 gestion, in early infancy, strongly indicate the necessity of an 
 especial regard being paid to the food of the child, to preserve it 
 even in common health, and to prevent the development of se- 
 veral painful and fatal diseases. Therefore, it has always been 
 found decidedly injurious, if not immediately fatal, to anticipate 
 the powers of the stomach, by offering food to it, which was be- 
 yond its capacity to digest — hence, the frequent development of 
 
 * We are always supposed, in our directions, to have reference to children in 
 good health : the medical treatment of them is a distinct consideration, 
 f Commentaries, p. 58. 
 
164 OF NURSING BY THE MOTHER. 
 
 consumption, scrofula, and rickets, at an early period of life in 
 the children of the poor, because food suitable to the ages of 
 children could not be procured ; or, in others, from the disre- 
 gard of a truth so obvious as, that a cfrild of a few days, or even 
 months old, cannot digest the food that may be proper for chil- 
 dren of a much more advanced period. 
 
 526. From the earliest period of medical history, the impor- 
 tance of this rule has been insisted on: for Hippocrates himself 
 inculcated its necessity, and strongly insisted upon its impor- 
 tance, and devoted a considerable part of his works to the subject 
 of diet.; nor have his cautions, or instructions, upon this point, 
 ever been disputed. Therefore, a deviation from the rule— 
 namelyj to accommodate the nature of the food to the age and 
 pow T ers of the child, should only be infringed from necessity. 
 
 527. Nature has ever been attentive to this subject, through- 
 out animal existence; she has governed the general system almost 
 exclusively by the powers of the stomach ; and we may trace 
 the influence of this law, from the simple hydatid to the most 
 perfect animal. She has so arranged the powers of the stomach, 
 that a departure from the general law which governs it, cannot 
 be made without evident injury, and perhaps death itself. Thus, 
 the cow cannot be made to live upon animal food, nor the tiger 
 upon vegetable, &c. The same general rule holds good with 
 regard to man, in the early, and after part of his existence. It 
 will be agreed upon by all, that the infant could not be made to 
 thrive upon the gross food necessary to adult age ; and that adult 
 age would be but ill sustained by the food of early infancy, 
 however abundant it might be in quantity. And the same prin- 
 ciple holds good in the whole class of mammalia. For in this 
 -class, milk is always the first article prepared for the sustenance 
 of the young of every species ; and they are confined to it uni- 
 versally, until fitted by a new arrangement of organization, to 
 profit by other food. 
 
 528. This law is more remarkable with man, perhaps, than 
 with any other animal; for the state of probation, if we may so 
 term it, is longer with him, than any other. The early parts of 
 his life, are marked by most important and distinct periods ; and 
 each period has its appropriate state of mouth, and powers of 
 stomach : thus, before the appearance of teeth, nothing can be 
 proper but the milk of the mother; after the appearance of some 
 
OF XURSING BY THE MOTHER. 105 
 
 -teeth, the addition of some farinaceous substance may be per- 
 mitted; and after their completion, or even a little earlier, ani- 
 mal substances may be added. 
 
 529. It is often asked, at what age will it be proper to make 
 a change in the diet of the child, by giving it a proportion of 
 animal food? This question must be answered by referring to a 
 principle, and not to a period of the child's life, marked by a 
 lapse of any number of months. Nature has declared by the 
 formation of the teeth, and by the organization of the stomach, 
 that man is a promiscuous feeder; and that a due mixture of ve- 
 getable and animal matter, is essential to his best and most per- 
 fect well being. The question now narrows itself, by asking, 
 -by what sign shall it be known, when a change of food can ad- 
 vantageously be introduced into the human stomach? This is 
 fully answered, we trust, above. If the cutting of teeth shall 
 mark the proper period for changes, (as we believe it does,) it 
 will at once be seen, it cannot be fixed by dates; since the cut- 
 ting employs from the third to the eighteenth month, or some- 
 times even longer.* And it would seem to follow, from these 
 -premises, that animal food cannot be given with propriety, even 
 in small portions, to a child, before the system has protruded the 
 grinding teeth ; therefore, we would say, as a general rule, it 
 would be improper, before that event has taken place. 
 
 530. After a child has got its grinding teeth, its food may be 
 a little more varied, as well as more substantial; yet it must con- 
 sist principally of milk, in which grated cracker may be stirred; 
 well baked stale bread; rice flour, or arrow root; and, occasion- 
 ally, a little animal food in substance may be given, provided it 
 be previously well divided; or, it may be used in the form of 
 broth, or tea. After the eye and stomach teeth have come 
 through, the child may be indulged daily, but only once a day, 
 with solid animal food, which has been either boiled or roasted; 
 as any other mode of cooking it is exceptionable. 
 
 531. An error is constantly committed, in the early exhibition 
 of animal food — it is imagined, that all kinds are equally proper, 
 and these either salted or fresh. And farther — if the child hap- 
 pen to be reduced by any cause, they suppose that the more fre- 
 
 * We have, at this moment, (May, 1825,) a little patient, seventeen months 
 old, who has not cut a tooth. 
 
166 OF NURSING BY THE MOTHER. 
 
 quently meat be given, the more the child will be benefited. 
 But such people should be made to understand, that it is only 
 that part which is digested that can be useful, and that this will 
 depend exclusively upon the powers of the stomach, and, more- 
 over, that these powers can be easily overstrained. And, in 
 corroboration of what we have just stated, it is agreeable to all 
 observation, that the healthiest children are those that eat the 
 least animal food. 
 
 532. Though the occasional and moderate employment of 
 animal food, may be sometimes necessary from peculiar circum- 
 stances after some teeth may have made their appearance, yet 
 the quantity, and quality, are not matters of indifference. It 
 should never be given in such quantity, in a solid form, as to 
 make it a meal, as the stomach, most probably, will be unable to 
 manage so great a bulk; and, certain it is, the exigencies of the 
 system cannot require it. The most proper mode to exhibit it, 
 is in a fluid form — such as beef, mutton, or chicken tea, without 
 any mixture of vegetable juices. These teas should be given 
 at such intervals, and in such quantities, as the deficiency of the 
 mother's milk, or the situation of the child, may render neces- 
 sary; or as a change of food may be judged important, from the 
 number of teeth; or when the advancement of the age of the 
 child may seem to require this additional stimulus, without such 
 a failure on the part of the mother. 
 
 533. It is not a matter of indifference, what animal is made 
 •choice of for its flesh — some are decidedly better than others. 
 Beef, mutton, fowl, are much to be preferred to veal, lamb, or 
 pork. Oysters are very unexceptionable articles of diet, when 
 made into a thin soup. In using, however, any of these articles, 
 especially in warm weather, care should be taken to have them 
 fresh ; as any progress towards decomposition would be highly 
 improper, if not really dangerous. Therefore, but small quan- 
 tities should be prepared at a time, and used as quickly as may 
 be, after. The lean parts of either of the. first named meats, 
 should be used in making a tea, or, if it be difficult to separate 
 the fat before boiling it, it is not so afterwards ; for if the product 
 be permitted to cool, the greasy portion can easily be separated. 
 The red juice which flows upon the cutting of under-done beef, 
 •or mutton, can very advantageously be employed, by adding an 
 
' OF NURSING BY THE MOTHER. 167 
 
 equal measure of water, and suffering it to boil — there should 
 always be a little salt added, and a blade of mace is a pleasant 
 and proper addition, especially in hot weather. Veal, or lamb, 
 may be used, provided the beef,- mutton, fowl, or oysters,* can- 
 not be procured : they must, however, always be looked upon 
 as inferior to the others. Pork is never admissible. 
 
 534. Regular periods, or nearly so, should be observed in 
 exhibiting the animal juice, that they need not interfere with 
 the digestion of the milk the ckild receives from the mother ; 
 therefore, it will always be best to give them at stated times, 
 taking care to let it be received upon an empty, or nearly an 
 empty stomach ; especially when this change is commencing. 
 The reason for this is, to ensure to the newly introduced sub- 
 stance the full powers of the stomach. 
 
 535. On this account, it is also right, that the mother observe, 
 after a certain time, some regulations as regards the periods for 
 suckling — we have elsewhere fixed the period at about the sixth 
 month. (516) Before this time, but little injury can be sustained 
 by a frequent indulgence at the breast; but after this, it becomes 
 highly' important, both as regards the mother and the child* 
 On the part of the mother, it prevents an over-stimulation, and 
 consequent weakness of the glands of the breast : it permits a 
 gradual . accumulation of milk in the milk-vessels, and gives 
 time to the nipples to recover their tone, and thus prevents their 
 becoming sore. On the part of the child, it prevents over-dis- 
 tention of the stomach ; it prevents fretfulness, or clamorous 
 demands for the breast ; and at night, especially, it permits it 
 to sleep, and thereby gives ample opportunity for the digestion 
 of the food it had previously received. On this account, it is 
 a good rule that the mother should suckle her child the last 
 thing before she goes to bed. 
 
 * Mr. Friedlander condemns oysters, as being- too heating. If this mean any 
 thing-, it must be, that they are too stimulating-. Now, this is very far from being- 
 confirmed by our own observation, or, we believe, that of any other physician in 
 this country. We have ever found them to be nutritious, and void of all stimu- 
 lating- qualities ; so much so, that they are the first article we indulg-e our patients 
 with, on their return to convalescence. He has ranked them, very unjustly, with 
 muscles, lobsters, crabs, &c, which are known to disagree very often, especially 
 in warm weather; whereas the oyster is very nutritious and bland, and rarely 
 offends, like the others, by any peculiar quality. 
 
168 OF NURSING BY THE MOTHER. 
 
 536. It is a common practice with many mothers., to permit 
 the child to go to sleep at the breast. This should always be 
 avoided, when possible ; for the fear in which this practice ori- 
 ginates, is purely chimerical — namely, that the child may suffer 
 during, the night for want of nourishment. The frequent taking 
 of the breast, is entirely a habit ; and one that is calculated to 
 do mischief; as both the rest and digestion of the child are inter- 
 rupted, to say nothing of the unnecessary fatigue to the mother. 
 
 537. Occasionally, we have known the stomach reject these 
 animal solutions. In such case, where. the change of diet is de- 
 sirable, w r e have found the substance itself, when divested en- 
 tirely of its fat, answer very well ; it should, however, always 
 be chopped up very fine, and given in very small quantities at a 
 time. By this plan of feeding, several advantages arise: 1st, the 
 child has the meat well divided by the knife, which could not 
 always be done by the teeth ; 2dly, if given in very small quanti- 
 ties, the child permits them to tarry in its mouth, until they be- 
 come saturated with saliva — a circumstance of very great con- 
 sequence to the process of digestion ; 3dly, it prevents the risk of 
 temporary strangulation, as the bulk is not sufficiently great, 
 when thus divided and given in small quantities, for this acci- 
 dent to take place ; consequently, a. disgust to the food is not ex- 
 cited. 
 
 538. At this period, also, that is, after a number of teeth are 
 cut, the child may very profitably be indulged in the use of 
 butter. Small pieces of good stale bread and butter may be 
 given several times a-day; the butter should, however, always 
 be of the best quality : and unless this can be ensured, it is de- 
 cidedly best it should not be given. Some young children will 
 not take it when spread upon bread ; it may then be given alone, 
 in small quantities at a time. 
 
 . 539. Strong prejudices are entertained by some against the 
 use of the last named article ; so much so, with a few, that it is 
 entirely prohibited to young children, and sometimes even to 
 older. The fear of butter originated in unfounded premises, and 
 is perpetuated by absurd deductions. It is said, that in this cli- 
 mate, especially in warm weather, our diseases are almost all 
 of a bilious character — butler is bilious; therefore, butter favours 
 this dangerous tendency of the body. This absurd logic ap- 
 
OF NURSING BY THE MOTHER. 169 
 
 pears to be the sum of evidence against the use of this delight- 
 ful, and highly useful substance. 
 
 540. For many years past, our habits as well as our duties* 
 have led us to make observations upon the use of butter, as an 
 article of diet, and especially for young children ; and, from all 
 that we can collect upon this subject, we are decidedly of opi- 
 nion, that it is not only innocent, but highly useful. It is grate- 
 ful to almost all children ; yet we do not recollect an instance, 
 where an indulgence in it was followed by the slightest injury, 
 provided the butter be good. And as a medicine, in certain 
 affections of the bowels, it constitutes in some instances an in- 
 valuable remedy, as we shall have occasion to notice in its 
 proper place. 
 
 541. Most people are in the habit of giving the potato to 
 children of the age we are now noticing. The propriety of this, 
 in our opinion, is very questionable ; and we think its use should 
 not only be very limited, but given with great caution. We' 
 have oftentimes witnessed very distressing results from the too 
 free use of this vegetable ; and especially when it has been given, 
 as it too frequently is, mixed with the gravy of meat* We have 
 seen many instances of indigestion, cholera, colic, and some- 
 times even convulsions, succeed a too free indulgence in this 
 article. If the potato be used, it should always be well mashed, 
 with a little hot milk, a small piece of fresh butter, and a little 
 salt. This is the most unexceptionable mode of using it ; and 
 even this should be given in small quantities at a time, and only 
 to children beyond the ninth month.* 
 
 542. To some stomachs, the potato is uniformly exception- 
 able; nor does a perseverance in its use, as has been often at- 
 
 * It must, however, be confessed, that the introduction of this highly valuable 
 root, has been attended with much good, even to young children, in countries 
 where the means of life are scarce, and, of course, difficult to procure among the 
 poorer classes of people. To these it has afforded a large supply of food, at a 
 very moderate expense, besides, its quality being absolutely better, than much of 
 that which they were obliged to employ before its introduction — therefore, com- 
 paratively, it is much better than many other roots before in common use. Thus, 
 Professor Lentin, (Friedknder, l'Education Physique de l'Homme,) informs us, 
 that the comparison of deaths in his parish, before, and since the introduction of 
 the potato, is much in favour of this article. But all this only declares in favour 
 of this root, where it is put in comparison with certain others; it does not prove 
 it to be the best, or even equal to many other articles; for instance, as good 
 wheat flour, rice, arrow root, sago, or tapioca. 
 
 22 
 
170 SECOND MEANS. 
 
 tempted, serve to reconcile it. This root does not contain as 
 much nourishment as is generally supposed ; and what there is, 
 is very difficult of extraction to even a slightly enfeebled sto- 
 mach. Who has not seen it pass through the bowels, in the 
 precise condition it entered the stomach ? And who has not 
 known this friendly warning disregarded, until serious injury 
 has arisen from a perseverance in its use ? 
 
 543. Many of the solid articles of diet, have been employed 
 merely because they were solid ; and this preference for solids 
 has arisen from the vulgar belief, that they are necessarily more 
 nutritious than fluids ; than which, in many instances, nothing 
 can be farther from the truth. Besides, it should be recollected, 
 that before a solid can be converted into nourishment, it must 
 be first reduced to the fluid state. 
 
 Sect. II. — Second Means; orzchere the Mother is obliged lo use ar- 
 tificial Means entirely. 
 
 544. When the woman is obliged to give up suckling her 
 child altogether, and prefers the second (520) to the third mode 
 of nourishing it, she is under the necessity of conveying food to 
 it, as we have already observed, (521) in one of two ways-— 
 namely, by the spoon, or by the bottle ; and we at that time 
 gave our reason for preferring the latter. We will now, how- 
 ever, say something farther on the subject of nourishing the 
 child by the bottle. 
 
 545. We consider the use of the sucking bottle, as a great 
 improvement in the rearing of children. Unquestionably, it is 
 one that is attended with the most entire success in very many 
 instances, though we at the same time admit it to be accom- 
 panied with considerable trouble, although it be administered 
 in the best manner ; and must always be regarded, but as a 
 substitute for the breast. But where the choice lies between it, 
 and a hireling nurse, we should without hesitation give it the 
 preference, unless our choice could be very securely made in 
 regard to the latter ; or there are existing some particular cir- 
 cumstances, which render the bottle improper. 
 
 546. There are cases, however, in which we should very 
 much prefer the breast ; and this even at the hazard which must 
 
SECOND MEANS. * 171 
 
 always attach, in making choice of a person to fulfil the impor- 
 tant duty of a nurse. These cases are, 1st, for a very young, 
 and feeble child : and especially where this weakness arises from 
 its immaturity; from a natural delicacy of constitution; or from 
 the previous illness of the mother; 2dly, where the mother has 
 a tainted constitution ; and which taint has been in other in- 
 stances, or may again be perpetuated to the offspring ; 3dly, 
 where the mother's milk has decidedly so far disagreed with the 
 child as to produce either bowel complaints or great wasting ; 
 4thly, where the child is recovering from illness, particularly 
 from complaints of the stomach, and bowels ; 5thly, and above 
 all, where the experiment of the bottle has been fairly tried, and 
 it has not been found to answer. 
 
 547. When the bottle is used, much care is required to pre- 
 serve it sweet, and free from all impurities, or the remains of 
 the former food, by which the present may be rendered impure, 
 or sour : for this purpose, the following cautions must be ob- 
 served :* — • 
 
 548. 1st. Never put a second supply of milk, or food, upon 
 the remains of a former, unless a very short interval, only, has 
 elapsed, and they are of the same making. 
 
 549. 2d. As soon as the child has taken as much as disposed, 
 or as may be judged proper for it, let the bottle be emptied, if 
 any food remain, and immediately cleansed by hot water. 
 
 550. 3d. When well cleansed by the hot water, let it be 
 thrown into, and kept in a basin of cold water, in which there 
 is a little soda dissolved. 
 
 551. 4th. Before using it, let it be well rinsed with clean cold 
 water. 
 
 552. 5th. Let the extremity, from which the child is to suck, 
 be covered with a heifer's teat, in preference to any thing else, 
 and, with a view to its preservation, the following rules must be 
 observed :-^ 
 
 553. 1st. Let this teat be one, that has been preserved in the 
 best possible manner, by those who understand this art. 
 
 554. 2dly. Let not the teat be of too large a size; nor one 
 
 * It is not the bottle alone which requires this strict attention to cleanliness; it 
 is every utensil that is employed, either in the preparing, or receiving the nou- 
 rishment of the child — for they may become either sour or impure, by some of 
 the victuals adhering to them; or they may be chemically acted upon: as vessels 
 made of copper, or glazed earthenware. 
 
172 SECOND MEANS. 
 
 that will permit too rapid a flow of the foooVespecially for a 
 very young child. If it be found to pass too freely, let the 
 piece of sponge which is, or always should be, at its extremity, 
 be either enlarged, or more strongly compressed. 
 
 555. 3dly. Immediately after the bottle has been used, re- 
 move the teat from its mouth; and let it and the sponge be well 
 washed and kept in a little whisky and water, until again 
 wanted. When reapplied, let it be attached by a piece of clean 
 thread, as the former piece will be sour. 
 
 556. From what we have said, it will appear, that we prefer 
 •the flat oblong bottle, with a teat to the bottle and tube — and 
 we do this for the following reasons : — 
 
 557. 1st. The extremity of the tube is never so well received 
 by the child, as the teat ; nor is it so comfortable to its mouth. 
 
 558. 2d. The tube frequently becomes obstructed by the curd 
 of the milk ; and it is oftentimes difficult to remove it ; and if 
 not removed, its objects will be defeated. 
 
 559. 3d. It is much less convenient; requiring much more 
 address in the management, of it, than the bottle. 
 
 560. 4th. It is much more difficult to keep clean or sweet ; 
 consequently, must be improper in proportion to that difficulty. 
 
 5th. Besides, the flat bottle and teat need no re-heating of 
 -the food during the night, as it can be taken into the bed, and 
 kept sufficiently warm by the heat of the body ; whereas, the 
 tube and bottle require that the food, must be warmed by a fire, 
 which is found to be extremely troublesome, or the child must 
 receive its nourishment cold. 
 
 561. The food for the child in this artificial nursing, is the 
 same as we have already recommended, (248,) when only par- 
 tially nursed by the bottle; namely, the cow's milk, water, and 
 sugar.* It should be frequently renewed, for the reasons we 
 have already given ; and it should never be made too tenacious 
 by the addition of other substances than those already recom- 
 mended, as it will not pass through the pores of the teat, or 
 through the tube with sufficient facility* 
 
 * It is sometimes extremely difficult to get " cow's milk" that is good and 
 sweet: in such case, an excellent substitute will be found in the "goat's milk," 
 which can almost always be procured. In some of our southern states milk 
 bears a high price, and is excessively bad, the scarcity tempts people to adulte- 
 rate it most plentifully with water, &c. The price of milk in Mobile is one 
 dollar per galion; this offers a strong temptation to this fraud. It turns sour 
 ^ery soon: I have known it to be unfit for use in less than five hours. 
 
SECOND MEANS. 173 
 
 562. Children brought up by artificial means in this country, 
 have subsisted almost altogether upon cow's milk, reduced, as 
 directed before. The European writers speak highly of the 
 milk of other animals: but of the qualities of these, we have 
 had no opportunities to judge. Thus, the milk of the goat, the 
 mare, the ass, &c, have been much praised for their nutritious, 
 and other qualities, by different writers. 
 
 5(53. Dr. Clarke,* of London, declares, " the milk of the ass 
 to be the best substitute for that of the mother. Cow's milk is 
 too rich, containing too much oil and cheesy matter." We will, 
 however, give the results, which the analyses of the milk of se- 
 veral animals have afforded, agreeably to MM. Parmentier, De? 
 yeux, and Yauquelin. 
 
 564. One hundred pounds of milk, gave of — 
 
 The Cow 
 
 Woman 
 
 Goat 
 
 Ass 
 
 Sheep 
 
 Mare 
 
 ' 565. From this statement it would appear, that the milk of the 
 ass dnd the mare, approach nearer to that of the human, than 
 any other yet analyzed. The milk of the mare is remarkable 
 for its containing so little cream, and so large a proportion of 
 sugar. 
 
 566. But the nearer we can approach the qualities of the 
 breast milk, the better will be our compound ; for nature has 
 declared this to be the best possible pabulum for the child ; and 
 there cannot well be a greater error, than to suppose every ad- 
 dition an improvement. We will not "say that the substance 
 just recommended is not susceptible of improvement : we mean 
 only to declare, the simple mixture just mentioned to be the 
 best we know for the child, up to a certain period — say, until 
 it has cut several teeth. After this time, w T e may, should it be 
 deemed necessary, improve its nutritive qualities, by the addi- 
 tion of gum Arabic w r ater; barley, or rice water. We think 
 we have seen decided advantages result from these additions, 
 particularly from the gum Arabic water. Or, small quantities of 
 
 • Commentaries, p, 56. 
 
 Cream.' 
 
 Butter. 
 
 Cheese. 
 
 Sugar 
 
 4iV 
 
 2J4 
 
 8}f 
 
 3y\ 
 
 *n 
 
 3 
 
 9U 
 
 7tV 
 
 m 
 
 4 T V 
 
 4| 
 
 4J 
 
 2M 
 
 
 m 
 
 4t*o 
 
 11 9 
 
 5U 
 
 !5| 
 
 ^ 
 
 1 3 
 
 
 If 
 
 9 T V 
 
174 SECOND MEANS. 
 
 some animal juice may be given in conjunction with the other 
 preparation. 
 
 567. But let it be recollected, much mischief sometimes arises 
 from a fastidious desire of improvement. The necessity for 
 alteration should always be ascertained, before the change is 
 made; for it would be more than idle, to insist upon a change 
 of diet, while the child is rapidly, or even perceptibly improving ; 
 especially as the quantity of its food can readily be increased, 
 in the precise ratio to the necessity for such increase. There- 
 fore, when it becomes desirable from any cause, (as in certain 
 stages of bowel complaints, &c.) that the quantity of food should 
 not be increased, we may, with much advantage, sometimes 
 increase its nutritive qualities, by the addition of the above 
 named substances. * 
 
 568. It would be very desirable, could it be always regulated 
 with sufficient certainty, to permit the child to take no more into 
 its stomach at a time, than this organ can assimilate in due 
 time ; for it has always been found better, that the stomach 
 crave food, than to be oppressed by an excess of it. The quan- 
 tity given at a time must be regulated by the age of the child, 
 and by the force of its digestive powers ; and the periods for 
 its exhibition must in some measure be governed by the same 
 laws. 
 
 569. As a general rule, such an interval should be allowed 
 between each feeding, as will ensure the digestion of the pre- 
 vious quantity ; and this may be fixed at about every three or 
 four hours. The quantity to be given at each period may pret- 
 ty successfully be determined, by the avidity with which the 
 child receives it ; for it will rarely demand more than it feels 
 comfortable to receive — therefore, a little experience will ena- 
 ble any body to determine this point. When this matter is set- 
 tled by repeated observation, it is proper that no more than has 
 been generally sufficient, should be urged upon the child at 
 that time, especially if it be taken rather reluctantly ; but 
 making at the same time due allowances for its advancing in- 
 crease of size. There will also be constitutional differences, as 
 to the quantity, which may be required ; but this, to a woman 
 of observation and care, will offer no embarrassment ; but it 
 should, nevertheless, be attended to, that an undue quantity 
 need not be urged upon the child in one instance, nor an insuf- 
 ficient one, be given at another. 
 
 570. There is one rule, which should constantly be attended 
 
SECOND MEANS. 175 
 
 to, especially as it is certain in its indication, and useful in its 
 observance ; namely, when the child ceases to extract milk from 
 the bottle,* and it be restored to it, and it refuse to take it, let 
 it not, on any account, be urged to swallow more than nature 
 seems to demand. We are aware that this will occasionally 
 happen, from a previous bad regulation — namely, feeding the 
 child just before it is offered the bottle. But, he this as it may, 
 the rule just laid down must be strictly observed. 
 
 571. With children who are nourished by the breast, this bu- 
 siness is left almost altogether with the feelings of the child; nor 
 is this rule, in general, attended with any serious consequences. 
 Should it take more than is really required, or than is agreeable 
 to the stomach, it is soon regurgitated, -and the uneasiness re- 
 moved. But it is not exactly so, in the artificial mode of rear- 
 ing children; for the stomach does not so readily yield its con- 
 tents, when it shall have become oppressed by quantity/ as it 
 does when it obtains its supplies from the breast ; and, on this 
 very account, the artificial mode is less proper than the natural. 
 It would seem, that the milk of the mother has some inherent 
 quality which provokes the action of the stomach to cast it off, 
 as soon as it becomes offensive ; but this is not so much the case 
 with the artificial food intended to supply its place. This, how- 
 ever, may arise from the one being drawn immediately from the 
 breast, while the other has been exposed to the atmosphere, and 
 suffered a change. The cow's milk contains more cheesy 
 matter; and is, on this account, of more difficult assimilation — 
 hence it is frequently thrown up in the form of hard curd. 
 
 572. The stomach, therefore, will be more liable to these lit- 
 tle inconveniences when confined to the bottle, than when it 
 shall receive its natural supplies ; but a little careful observation 
 on the part of the nurse, will prevent any serious injury from 
 this cause, as she will soon become familiar with the proper 
 quantity to be administered ; or, in other words, how much the 
 stomach will bear, without suffering from repletion. The qua- 
 lity of the food can be pretty much subjected to rule, by having 
 regular proportions of the respective ingredients; and habit will 
 soon enable a careful and observing woman to determine the 
 quantity. 
 
 * This observation will hold good, and should be carefully observed, when, 
 the child is at the breast altogether. 
 
176 SECOND MEANS. 
 
 573. We have already, upon several occasions, adverted to 
 the care that is required in preparing, and preserving in a pro- 
 per condition the milk intended for the use of the child; we 
 shall, therefore, only observe, in addition, that, upon no occa- 
 sion, when the child is in health, will the milk require boiling. 
 Boiling takes from the milk some of its best qualities, as may 
 readily be detected by the smell, when this fluid has been sub- 
 jected to it. It should, therefore, never suffer this change, as 
 it can never be necessary while the child is in health. 
 
 574. Jn hot weather, it is true, the tendency to decomposition 
 is diminished by boiling the milk ; but, as all the advantages 
 which may result from this process can be procured without its 
 being absolutely boiled, it should never be had recourse to. It 
 is every way sufficient for the purposes of preservation, that the 
 milk be put, closely covered, over a hot fire, and brought quick- 
 ly to the boiling point: as soon as this is perceived, it should be 
 removed and cooled as speedily as possible.* By this plan, you 
 prevent, in a great degree, the formation of that strong pellicle, 
 which is always observed upon the top of boiled milk, and by 
 which the milk is deprived of a portion of one of its most va- 
 luable parts. 
 
 575. The child should not receive its nourishment while lying 
 —it should be raised, which will not only become a pleasanter 
 position, but it also diminishes the risk of strangulation. After 
 it has received a sufficient quantity of nourishment, which it 
 should always do slowly, by stopping from time to time; it 
 should be kept perfectly quiet for at least half an hour after each 
 repast; and if an attempt be made to use the common nursery 
 promoter of digestion, namely, jolting, it should be immediately 
 prohibited in the most decided and positive terms. This pre- 
 posterous and highly injurious practice has become so familiar 
 as to be overlooked as a cause of mischief; yet it merits more 
 severe reprehension than might at first sight be imagined. 
 
 576. As the future welfare of the child must necessarily, in 
 part, depend upon the proper administration of its nourishment 
 in the early part of its infancy, it must follow, if the due exhi- 
 
 * An excellent method to warm milk, is by a sand bath; which any body may 
 command, by partly filling an iron pot with dry sand. If the milk be placed in 
 a proper vessel in this bath, it may be heated by setting it over coals, or it may 
 be placed upon a stove until it acquires a proper warmth. 
 
SECOND MEANS. 177 
 
 bition of it as regards quality and quantity be neglected, all the 
 evils which can attach to deranged stomach and bowels, must 
 follow; and if, on the other hand, there be no complaint to be 
 made as to these two points, but, on the contrary, they are regu- 
 larly and judiciously ordered, but all their advantages destroyed 
 by digestion being interrupted, it must follow, that the practice 
 which shall do this, cannot be too severely condemned — there- 
 fore, the barbarous practice of jolting the child immediately af- 
 ter each meal, or, perhaps, after each portion of it, should be 
 strictly forbidden. 
 
 577. For a certain period after each meal, rest is as essential 
 to digestion, as exercise is important at other times to the gene- 
 ral promotion of health — therefore, whatever interrupts or in- 
 terferes with this repose, at once defeats the kindest intentions of. 
 nature, toward this passive and interesting part of creation. 
 Analogous to jolting, is the absurd, and oftentimes dangerous 
 /practice of tossing the child high, in such quick succession, that 
 respiration is oftentimes suspended. Some seem to know no 
 other mode of nursing a young child, than that of rudely tossing 
 it about; and we have oftentimes been gratified by the disturbed 
 stomach, indignantly pouring out its contents, to the dreadful 
 annoyance of the holiday clothes of the boisterous, and thought- 
 less pro tempore nurse, who forced it to this retaliation. No* 
 thing can speak in plainer language than the insulted stomach, 
 upon such occasions ; as it at once declares the evils which 
 .must ensue, whenever its functions are thus cruelly interfered 
 with. 
 
 578. We have often observed the bottle to become the play- 
 thing of the child. This has arisen, most probably, from the 
 mother or nurse not having as much leisure as duties to the child 
 might require — the bottle is then given to appease its immediate 
 .clamours, and afterwards suffered to remain with it, that they 
 may not be renewed. This is decidedly very injudicious, if any 
 thing more than quieting the child be considered of any conse- 
 quence. 
 
 579. By this plan, the child receives a fresh supply of food 
 every few minutes, without giving time for the previous quanti- 
 ty to be disposed of; the process of digestion is, therefore, never 
 completed, or is constantly interrupted. In consequence of this, 
 a great part of the food passes from the stomach into the bowels, 
 
 23 
 
178 SECOND MEANS. 
 
 - 
 
 nearly in the condition it was received, or but imperfectly as- 
 similated ; and it is there subjected to a sufficiently long delay, 
 to ferment, or to become sour ; colic, or diarrhoea, or both, are 
 the result. Besides, the child is deprived, by this plan, of a con- 
 siderable portion of its nourishment ; for not only that which 
 has undergone a change, but also that which has not, escapes 
 from the stomach, and passes through the bowels, without con- 
 tributing to the nourishment of the body. Hence, children who 
 are always eating, are never fat. 
 
 580. There is also another evil arising from this mode of ad- 
 ministering nourishment to the child — namely, the food becomes 
 sour, or nearly so, before it is taken into the stomach, by its be- 
 ing kept constantly heated by the child's hands and body — the 
 impropriety of this, will at once strike every body. 
 
 581. Rousseau has advanced some strange sentiments upon 
 the subject of milk. He says, " The milk of those women who 
 live chiefly on vegetables is more sweet and salutary than that 
 of carnivorous females." More salutary to whom, or to what? 
 Does not this imply an imperfection, and a contradiction, in the 
 works of nature? The milk produced by a mixed diet would 
 certainly be most proper for such animals as naturally live upon 
 mixed food ; but would this be as sweet and as salutary to the 
 young of the animal which feeds upon animal substances alone? 
 We believe not — for there is every reason to suppose the milk 
 to be suited exactly to the powers of their digestive organs. If 
 he mean, that the milk of animals strictly carnivorous would be 
 less sweet and salutary to those who are destined to be supported 
 by milk from a mixed diet, we would most readily agree with 
 him ; but this would be begging the question. Now, as there is 
 not in civilized life, one woman in ten thousand, who lives upon 
 animal food alone, it must follow, that children deriving nou- 
 rishment from the breast, must receive milk of a mixed charac- 
 ter ; and that appears to be as much as we have a right to ex- 
 pect. 
 
 582. If there be any truth in the opinion of naturalists upon 
 the nature of man as regards his food, it will be* found, that he 
 is intended to eat of both animal and vegetable substances ; 
 therefore, to confine him exclusively to either, would be as* pre- 
 posterous, as to urge animal substances upon the cow, or to 
 force vegetables on the tiger. 
 
SECOND MEANS. 179 
 
 5S3. Rousseau farther attempts to support his position, by 
 declaring that " every body knows that pulse and vegetables 
 increase the quantity of blood more than meat." Now, this is 
 not known to every body, nor to any body, and, consequently, 
 his question, "Why, therefore, not milk?" which immediately 
 follows, and is intended as a deduction, answers itself. 
 
 584. He admits, that vegetable aliment may, possibly, make 
 the milk more apt to turn sour ; but he says, " I am very far 
 from regarding sour milk as an unwholesome nutriment. There 
 are people in some countries who have no other, and yet are in 
 good health." This is novel to us — and we regret he Jias not 
 left us some indication of the country where the caws give no- 
 thing but sour milk. He most probably means, there are peo- 
 ple who prefer milk in this condition, to sweet — this may be ; 
 but we do not believe there is a nation subsisting upon sour milk 
 alone, and in good health, as this passage w r ould seem to imply. 
 
 585. This observation is not confirmed by any other writer; 
 it is certainly contrary to our own experience, and we believe 
 to that of every body else, who has not a theory to support. 
 But Rousseau appears to be determined upon this point, since 
 he enlists in his favour the circumstance, that milk must be 
 coagulated* in the stomach, before it is converted into nourish- 
 ment. But he was an indifferent physiologist, or he would have 
 known, that the change produced upon the milk, by the proper 
 action of the stomach, is very different from that curdling which 
 is the effect of spontaneous decomposition ; the one is necessary 
 to its due elaboration ; the other, if not positively injurious, 
 taxes the powers of the stomach pretty highly to subdue it to 
 proper chyme.t 
 
 580. It will also readily occur, to any one who will give this 
 important matter a due consideration, that the bottle with mo- 
 thers, or nurses who are too much limited for time to bestow 
 the necessary attentions on the child, will not succeed so well as it 
 does in the hands of those who have more leisure; for their re- 
 stricted time prevents such attention to the state of the bottle that 
 is so essential to its success. If due care be not paid to its being 
 
 * But the coagulation alluded to by Rousseau, and which takes place spon= 
 taneously in the stomach of healthy children, is not the coagulation produced by 
 acidity; it is similar to that which takes place out of the body by "rennet.'* 
 
 j Chyme is the imperfectly digested mass, that is subjected to the influence 
 of the bile and pancreatic juice in the duodenum, that it may be converted into 
 chvle after it leaves the stomach. 
 
180 THIRD MEANS. 
 
 properly, and very often cleansed, it must fail of being as use- 
 ful to the child as it should be. Cleanliness must, therefore, in 
 this as it is in many other instances, be considered as a sine qua 
 iion to the success of the bottle plan, of raising children. 
 
 587. We mentioned, in our account of the manner of pre- 
 paring the cow's milk for the use of the child, (248,) that a small 
 portion of loaf sugar should be added ; but did not, at that time, 
 lay much stress upon this ingredient. We shall, therefore, take 
 this opportunity to observe, that this direction should always be 
 strictly complied with ; for the substitution of brown sugar, or 
 molasses, may often be attended with much inconvenience ,. 
 especially with very young children, by becoming acid much 
 sooner than good loaf sugar ; and for a purpose like this, the 
 difference of price cannot be considered an object. 
 
 Sect. UK — Third Means, or employing a wet JVurse. 
 
 588. We have already stated, that, under some circumstances^ 
 a "wet nurse, 5 ' with all the penalties that may attend the choice, 
 is to be preferred to the greater, or worse risk, of the child pe- 
 rishing without one. But as this is a matter of necessity, and^ 
 not of election; we must endeavour to diminish the evil as much 
 as may be in our power by selecting with as much care and 
 judgment as circumstances will permit, one with as few faults as 
 possible. There is, oftentimes, a great difference in those who 
 may offer for this purpose ; so much so, indeed, as to render it 
 highly important to be acquainted with a few general rules, to 
 aid in the selection. 
 
 589. It may justly be a question in morals, how far one part 
 of society has a right to be benefited, by the injury of another.- 
 The avowed object in employing a wet nurse, is to benefit the 
 child for whom she is employed. To do this, she must general* 
 ly abandon her own child, either to a mercenary as selfish as 
 herself, or allow it to be brought up by ill-conducted, or worse 
 adopted means; for the mother who abandons her own child to 
 suckle that of another, must do it from the expectation of gain :• 
 this she cannot realize, but by procuring a place for her own, at 
 a price lower than than which she herself is receiving; and,unfor^ 
 tunately for the poor child, this kind of calculation is but too 
 well understood by that class of people, to whom these remarks 
 
THIRD MEANS, 181 
 
 will apply ; for they will most scrupulously regulate the quid 
 pro quo, by the sine qua non. 
 
 590. On this subject, Dr. Clarke makes the following pointed, 
 but just remarks : " If the child live, for whom the wet nurse is 
 invited by the prospect of gain to forsake her own, the child of 
 the wet nurse often dies, or it becomes diseased, or crippled. 
 Her other children are neglected, and her husband, for want of 
 her society, becomes drunken and profligate ; she rarely returns 
 home contented with her former situation, but compares her 
 present privations with the indulgences which she has left; the 
 whole comfort of the labouring man's fire-side is broken up, and 
 society has onlv exchanged the life of one child for that of an- 
 other, with all the disadvantages above enumerated." 
 
 591. "On the whole," continues the Dr., "it would be bet- 
 ter, perhaps, that the children of the wealthy should be brought 
 up artificially, where the mother does not suckle, because they 
 would have every advantage of good nursing, cleanliness, air, 
 and medical treatment; and Vv'ould therefore have a better 
 chance of living, than the child of the wet nurse, who w r ill want 
 all these advantages."* 
 
 592. In our opinion, there is but one method to remove the 
 objections so strongly and truly urged against the system of wet 
 nursing here described, and this is very far from being free from 
 objections; which is, by employing none, but those unfortunate 
 females, who have been by " love betrayed," and such only of 
 these as may have lost their children. This plan would conside- 
 rably reduce the number of hireling nurses; but, from this very 
 circumstance, we see that several serious disadvantages might 
 arise : 1st, it would lead, in many instances, perhaps, to the ne- 
 glect, and ultimate death, of their own children; 2dly, itw T ould 
 increase very much the price of the*ir services, which would 
 operate as a bounty on their want of chastity. This view of the 
 subject, should, therefore, become an additional reason to the 
 mother to suckle her own child, wherever practicable. 
 
 593. It is true, Dr. Clarke proposes another plan, which in 
 our opinion is as liable to objections : but we will give his scheme 
 in his own words. " With every attention which can be paid to 
 them, children brought up by hand will often die. Perhaps, the 
 
 * Commentaries, p. 52. 
 
182 THIRD MEANS. 
 
 most desirable thing would be, that a strong wet nurse should, a& 
 far as she is able, suckle her own and the foster child ; and that 
 the deficiency of both, should be supplied by artificial means."* 
 
 594. The objection to this plan, is at once obvious, by refer- 
 ring to a principle in human nature, and on which we have 
 elsewhere passed a remark, (615,) that the child of the nurse 
 would be nourished, to the exclusion of the foster child. But, 
 to return. 
 
 595. Did we undertake to declare in what a good nurse con- 
 sists, " we should be considered," says Mr. Friedlander,f " as 
 describing an ideal being. For she should neither be too young 
 nor too old; as, before she is twenty, she has not arrived at her 
 full development; and, after thirty-five, she is upon the decline. 
 She should be well constituted ; she should be neither too fat nor 
 too lean; she should be fresh-coloured; have fine teeth, red lips, 
 and sweet breath ; her hair should not be too black, nor too deep 
 a red, nor should she be subject to any violent passion. Her 
 breast should be of moderate size* with a nipple sufficiently pro- 
 jecting and irritable, and yielding milk upon the slightest force ; 
 her milk should be neither too thick nor too transparent, and of 
 an agreeable, sweet taste. Added to these, she should have 
 proper moral feelings, to second such useful qualities. Nor 
 should these good qualities be debased by bad passions, or other 
 defect of character. She should so regulate her diet, as to be 
 entirely subservient to'the advantage of the child." 
 
 596. Or, as this has been more elegantly expressed by Sainl 
 Marthe, in his Fcedotrophia, as translated by Dr. Tytler : 
 
 " Choose one of middle age, nor old nor young - , 
 Nor plump, nor slim her make, but firm and strong: 
 Upon her cheek, let health refulgent glow, 
 In vivid colours, $ that good humour show. 
 Long be her arms, and broad her ample chest, 
 Her neck be finely turned, and full her breast: 
 Let the twin hills be white a* mountain snow, 
 » Their swelling veins, with circling juices flow; 
 
 Each in a well projecting nipple end, 
 And milk in copious streams from these descend 
 
 * Commentaries, p. 54. 
 
 f L'Education Physique de l'Homme, p. 60. 
 
 \ This rule, however, in this country, at least, is liable to many exception 
 since the very best nurses we have ever seen, have been pale* 
 
THIRD MEANS. 1S3 
 
 Remember, too, the whitest milk you meet, 
 Of grateful flavour, pleasing- taste, and sweet, 
 Is always best; and if it strongly scent 
 The air, some latent ill, the vessels vent." 
 
 597. To this we would add, (what appears to have escaped 
 the above judicious authors,) an exemption from her catamenia. 
 We are, however, by no means sure, that he, and many beside, 
 would consider this a defect in the character of a nurse, as ge- 
 neral opinion is in its favour :* on this account, it is worthy of 
 investigation. It is a very common belief among females, that 
 at each return of the catamenial discharge during lactation, there 
 is a renewal of " the milk." We have very often had this cir- 
 cumstance whispered in our ear by some good old woman, who 
 might be recommending a young friend for the office in ques- 
 tion, with an emphasis, that bespoke at least the firmness of her 
 belief, if not the soundness of her philosophy. Indeed, so com- 
 mon is this opinion among " nurses," that it has even been " si- 
 mulated," to enhance the value of the applicant, and to ensure 
 her success. 
 
 598. But, unfortunately for such as may attempt to take ad- 
 vantage of such a circumstance, or impose by a mere declara- 
 tion of it, it must, by all who will duly weigh the subject, be 
 considered as operating against the fitness of the individual who 
 may be so situated. For nature neither acts idly, nor capri- 
 ciously : and, though there may be occasional deviations from 
 her usual scheme, they must be regarded but as exceptions to 
 the general rule. 
 
 599. The laws of nature on the subject in question, are almost 
 invariably as follows: — 1st, As soon as the catamenial discharge 
 is arrested, in consequence of pregnancy, the breasts almost im- 
 mediately undergo a change; a change which is important, be- 
 cause preparative. of the great office they are to perform subse- 
 quently. 2dly, as soon almost as delivery has taken place, the 
 breasts plentifully secrete nourishment for the child, and during 
 a long period, faithfully discharge this important duty ; but in 
 the mean time, the catamenial evacuation is arrested, and con- 
 tinues to be so, in most instances, to any period almost, that the 
 
 * Struve observes, upon this subject, (p. 233,) "A nurse's monthly dis- 
 charges should either stop entirely, or take place only in a moderate degree, lest 
 the milk might soon disappear." 
 
 f 
 
184 THIRD MEANS, 
 
 child may continue at the breast. Udly, At the time appointed, 
 as a general law of nature, for the reappearance of the catame- 
 nia, (which is from the twelfth to the fourteenth month,) and 
 this evacuation is again established, the milk is found invariably 
 to diminish in quantity, and, also, to deteriorate in quality; and 
 the child to be but imperfectly nourished. The truth of these 
 positions, we are sure, will not be challenged. 
 
 600. Now, if this be true, is it not worse "than idle to declare, 
 that the exception which nature makes to her general "rule, should 
 be better calculated for the good of the being, than the rule it- 
 self? If this discharge were so efficient in the production of milk 
 for the benefit of the child, why would not nature have chosen 
 this for the general law, and the suppression of it, for the excep- 
 tion? Or, why is the milk not renewed and* improved, upon the 
 natural return of this evacuation? For these reasons, we have 
 invariably objected to such nurses. Dr. Marshall Hall says,* 
 " It has been noticed, that the return of the catamenial period is 
 usually attended by a tumid state of the mammas. It is not, 
 therefore, surprising, that a diseased state of the uterine functions 
 should induce a morbid condition of the latter organ. Such a 
 morbid condition of the uterus may, indeed, be frequently traced 
 as the cause of a morbid affection of the mammas: in some cases 
 it has excited tumours in the substance of the mammas; in other 
 instances, it has disordered their secretion, and ultimately 
 proved the cause of derangement of the health of the infant. 
 A familiar example of this occurs in those mothers who have be- 
 gun to menstruate before they have ceased from suckling: at 
 each return of the catamenia the child is, in many instances, 
 distinctly disordered in health." 
 
 601. The age of the milk, as it is called, should constantly be 
 taken into consideration. This is always an important point; and 
 its, value is well known to those, who are to be subjected to in- 
 quiry, since they will always declare it to be of an early age, 
 should this be necessary. We have no certain marks to direct 
 us upon this point: we have, therefore, almost exclusively to rely 
 upon the testimony of those whose interest it is to deceive, should 
 the truth make against them. When truth can be elicited, ei- 
 ther by testimony, or circumstance, we should always prefer the 
 
 • On some of the Diseases of Females, p. 142. 
 
% ■ THIRD MEANS. 185 
 
 v 
 
 " young milk," when it can be had, even for an older child, pro- 
 vided, the disparity be not too great: and for this plain reason: — 
 it will, (all things being equal) last longer, and in better condi- 
 tion. 
 
 602. It is a received opinion, and generally if is well founded, 
 that the substituted milk should be, as nearly as possible, of the 
 same age as the child who is to receive it. In many instances,, 
 there cannot be any disadvantage in the observance of this rule, 
 but there need be no absolute conformity to it; since there is no 
 necessary and'progressive correspondence in the age of the child 
 and- the quality of the milk, after the third or fourth month. Up 
 to this period, as a general rule, the milk is not so nutritious as 
 afterward ; but this defect, if it be so, is almost constantly com- 
 pensated for, by its greater' abundance; and this excess can be 
 profitably employed by an- older child, so that even this young 
 milk for an older child cannot be considered as a serious objec- 
 tion. But the converse of this rule will not hold good; nor 
 should it ever be acted upon, but as a dernier resource, since, 
 after the twelfth or thirteenth month, the milk almost always 
 diminishes in quantity, as well as deteriorates in quality. 
 
 603. Yet it must be confessed, there is no fact, perhaps, bet- 
 ter ascertained, than that the milk undergoes changes as the 
 period increases from the time of delivery, but not always ad- 
 vantageously ; that is, is less nutritious in the first few months, 
 than it becomes afterwards, in obedience to the law we have 
 elsewhere recognised; namely, that the nutritive quality of the 
 milk is generally governed 1 by the capacity of the stomach to- 
 digest it, and, by the greater or less necessities of the system. 
 This rule, however, has its limits, agreeably to -another law — * 
 that, as the teeth begin to show themselves, the milk maybe 
 aided by the administration of other substances, as the increasing 
 demand of the system may require such aid ; hence, as has just 
 been observed, the deterioriation of the milk after the twelfth 
 or thirteenth month. 
 
 G04. A nurse should be able to suckle with both breasts; not 
 altogether, perhaps, from the apprehension, that one may not 
 be able to furnish a sufficient supply ; but because, when the 
 child is constantly nursed from one, it sometimes contracts a 
 crookedness of form. And we may also urge, collaterally,- 
 there will be, most probably, not only a more abundant supply, 
 
 24 
 
186 THIRD MEANS. * 
 
 but also a greater security for its continuance from two ; since 
 an accident may befall the one, and thus deprive the child at 
 once of its nourishment. 
 
 605. We may also urge another observance upon women who 
 suckle from both breasts, and which should not be neglected, 
 and it may be considered as an additional argument in favour 
 of two breasts — namely, that the child may be nourished alter- 
 nately from them, to prevent the constant direction of its eyes 
 towards one point,. and thus produce the ugly habit of squint- 
 ing. This direction should be acted upon from the beginning, 
 that the child may not have a favourite breast established; 
 which is very apt to be done, by a little carelessness on the part 
 of the nurse, or from' some cause in the breast itself. 
 
 606. On the part of the nurse, this habit may be produced, 
 by her being able to manage the child more adroitly on one 
 side than the other ; and, on the part of the breast itself, it may 
 be owing to the nipple being better on the one breast than on 
 the other : or to the milk coming freer from one breast than 
 the other ; or its being too free from one of the breasts. This 
 caprice of the child, however, should not be indulged, if it can 
 possibly be prevented, and for reasons that may be collected 
 from what has just been said. 
 
 607. It is far from being uncommon for the milk to flow too 
 rapidly for the feeble powers of deglutition of the child ; thus 
 threatening it with strangulation. When a nipple is thus situ- 
 ated the mother should try to prevent it, by gently compressing 
 it while the child is sucking. We have known nurses obviate 
 this inconvenience, by making a ligature of white yarn, to press 
 gently around -the nipple. 
 
 608. Much reliance is placed upon the appearance of the milk; 
 more, perhaps, than it really deserves; since there is, most proba- 
 bly, a slight difference in appearance in each individual, as well; 
 as from the age of the milk itself, without necessarily affecting: 
 its properties ; at least, we know this to be the case with the milk 
 of cows. Farmers who are in the habit of attending much to cat- 
 tle, will, from the colour and form of the cow, very nearly de- 
 termine her capacity to produce milk, either as regards its quan- 
 tity, or its power to yield cream. Yet, in neither of these in- 
 stances, would one milk be said to be more wholesome than the 
 other. It is, therefore, possible that complexion in the human 
 
• THIRD MEANS. 187 
 
 female may have a certain quality of milk attached to it ; and 
 hence, perhaps, arise the objections to the very black, or very 
 red-haired woman, who may present themselves as nurses : in 
 either of which, the milk may not be found equal in quality, to 
 that yielded by women who have hair of the intermediate shades 
 of colour. 
 
 609. But, perhaps, in the red-haired woman, there may be 
 certain moral qualities, that may unfit them for the office of 
 nurses : they are certainly of a sanguine temperament, and this 
 temperament has attached to it great irritability of temper, as 
 one of its characteristics— hence, in a moral point of view, their 
 unfitness as protectors of young children. Among the ancients, 
 especially among the Romans, the moral qualities were con- 
 sidered of more consequence than the physical capacities of a 
 nurse ; and by them consequences of such moment and extent 
 were attributed to them, as, at the present day, at least, we* 
 should not expect to find realized. The habit of intoxication* 
 to which Nero so immoderately yielded himself, was said to be 
 owing to the influence of a drunken nurse ; and the blood-thirsty 
 disposition of Caligula was attributed to the nipple being smeared 
 with blood, to invite him to take it with more certainty, by his 
 savage foster parent. 
 
 610. We have never ourselves looked upon these stories, but 
 as powerful and ingenious fables, to rouse the sympathies of the 
 mother to the delightful duty of nursing her own child. But 
 every body is aware of the influence of example — too much 
 care, therefore, cannot be taken, that the nurse exhibit no im- 
 proper ones. Every precaution will be observed on her part to 
 conceal her frailties, however watchful the mother may be to 
 detect them ; for this reason, the child should be as little as may 
 be from under the mother's eye, that the evil may thereby be 
 diminished as much as possible. Let the nurse be considered 
 as the organ of supply, but not as the object of example ; com- 
 mit to her charge as few duties as possible, and let the mother 
 assume to herself every other but that of suckling, and a few of 
 the meaner, mechanical parts, which should, and must properly 
 be considered, as belonging to the nurse. 
 
 61 J. If this were more constantly done, it would tend much 
 to diminish the inconvenience, and at the same time remove 
 many of the objections, to the " wet nurse ;" for by it many 
 
188 THIRD MEANS. 
 
 evils would be removed. By this plan, the affections of the 
 child would be as much due to the real, as to the foster mother; 
 and that most painful of all sensations, of seeing the a'ffections 
 of our child transferred to another, would in a great measure be 
 avoided. By this plan, the manners of the plastic child could 
 be moulded by the will of its proper guardian, instead of being 
 subjected to that of a hireling. And, though last, perhaps not 
 least, the affections, of the parent would -not be estranged from 
 that child, which necessity had obliged her to rear by an alien 
 breast. We are well acquainted with the father and mother of 
 a child that was nursed abroad; and though they frequently saw 
 it, and it was returned to them at eighteen months old, they Doth 
 confess they have less affection for this little unfortunat-e, than 
 for the rest of their children. It is a source of constant misery 
 to them; and though the child is perfectly a -stranger to the di- 
 minished affection of its parents, and has in every respect the 
 ^ame attention, and the same apparent love bestowed upon it, 
 and, consequently, by these means suffers no real injury, still, to 
 the parents, it is the cause of endless regret. We confess there 
 may be a little too much refinement in this kind of sensibility; 
 since with them, or rather with the mother, it amounts to self-re- 
 proach, though the necessity of sending the child away was im- 
 perious: but a fear is constantly presenting itself to her over-sen- 
 sitive mind, that she may fail in her duties towards it, though she 
 is constantly watching herself, to prevent the slightest neglect. 
 
 612. With feelings like these, there can be little risk that the 
 child will suffer from neglect, but if such apprehensions arise in 
 the mind of a conscientious mother, what may not actually hap- 
 pen with those who have no such scruples against which to con- 
 tend ? It, at least, makes an additional, as well as a strong ob- 
 jection against wet nursing; and especially against that still more 
 exceptionable form of it, putting the child out of the house for 
 the purpose. By this practice, all the evils which can possibly 
 befall an infant repudiated from its mother's bosom, will exist in 
 a higher degree, than when it may be nourished in the house; 
 because it is now removed from the surveillance of a watchful 
 parent ; the only security it can have, that proper attention shall 
 be bestowed upon it. 
 
 613. Here, it will be doomed to all the penalties, that await 
 neglect of every kind, by the absence of the only feelmg, 
 
THIRD MEANS. 189 
 
 that can bear up against the exercise of it — namely, a mo- 
 ther's love. Ask any mother, how much love it requires to ful- 
 •fil, justly, the duties of one! Then ask, can these duties, du- 
 ties so varied, so multiplied, so essential to the happiness, nay, 
 almost the existence of the helpless little one, be performed in 
 :the absence of such affection ? The answer is no less easy, 
 than true— No! We will not go so far as to say, that there is 
 no exception to this rule— we believe, there may have been, 
 -and may be again : but the chance is like the high prize of every 
 lottery; and, like all dealers in this species of gambling, each 
 trusts he may be the holder of the fortunate ticket ; and the evil 
 is thus perpetuated. 
 
 614. Nothing will so certainly ensure neglect to the child, as 
 a want of affection for it — whether this want of love be on the 
 part of the mother or the nurse. It is unnatural on the part of 
 the mother, and it must be sorely lamented that it happens ; 
 ■since, from the want of it, she is deprived of one of the purest 
 pleasures on this earth; and, at the same time, loses the strong- 
 est incentive to the discharge of her duties. On the part of the 
 nurse, it is not to be so much wondered at, or so severely con- 
 demned ; for she has either lost her own child, and cannot sud- 
 denly transfer her affections to another ; or it is put from her by 
 ■necessity, that she may foster the child of a stranger : — she 
 dwells upon her privation ; her mind teems with a thousand ap- 
 prehensions; and, in spite of her best wishes to the contrary, she 
 must look upon her little charge as a usurper of the rights of 
 her own. During this period of conflict, the child is often the 
 sufferer, from a want of that attention, which a proper affection 
 would have ensured, and dies, perhaps, before this necessary love 
 is generated, because it had been too long withheld. 
 
 615. Let us, for a moment, look more closely at the case we 
 are now considering, that its enormities may the more easily be 
 ■exposed. A woman consents that a child shall share her bosom 
 with her own; the motive, doubtless, is, the reward it will bring, 
 — this, at once, declares, that poverty or avarice is the cause of 
 •that motive; it is, therefore, a mercenary transaction. She is 
 remote from the watchful superintendence of a mother who has 
 committed her child to her care; she is, consequently, under no 
 restraint as to conduct: the child is, therefore, treated as circum- 
 stances or caprice may direct. If a deficiency of milk occur, an 
 event common to all nurses, and an allowance is to be awarded, 
 
190 THIRD MEANS, 
 
 to which is it natural she should give the larger share ? Her own 
 child ! Or, perhaps, she may yield the whole ; making the other 
 conform to the necessity, by giving it an improper substitute, 
 for the milk of her breast. Again: if the child be not deprived 
 of its proper nourishment, it may be sadly abridged of the time 
 necessary to its comfort, or essential to its health — filth and all 
 kinds of uncleanliness, and even disease, dependent upon ne- 
 glect, will be heaped upon the passive child thus committed to 
 the care of an unprincipled nurse, because a mother's eye can- 
 not watch, or a mother's vengeance overtake, the horrid breach 
 of trust. 
 
 616. Besides, other evils may arise, of a still more serious 
 kind, by this mode of nursing. Dr. Struve, (p. 235,) quotes an 
 anonymous German author of a work on " Matrimony," for an 
 anecdote of a young Count, whose features bear so exact a re- 
 semblance to those of his foster mother, that a strong presump- 
 tion arises against the justice of his claims, to the paternal title 
 and estate — dreadful substitution ! 
 
 617. When necessity obliges a parent to put away her child, 
 let her seek a home for it in the country ; and, if possible, place 
 it with one who may have had the misfortune to lose her own ; 
 and whose situation in life would place her above a mere mer- 
 cenary hireling. So placed, the child would have the best pos- 
 sible chance for health, care and proper nourishment — conse- 
 quently, the great ends of nursing would be entirely answered. 
 It can never be safe to trust a child for this purpose in a city, 
 for reasons sufficiently obvious, — it cannot receive the benefit 
 of fresh air, especially in the summer ; it cannot have that at- 
 tention paid to cleanliness, that is so important to its health; nor 
 receive a sufficient quantity of nourishment, if it divide the 
 quantity with another ; since the person who would undertake 
 the charge, cannot live in a proper situation to afford the first, 
 nor will she have leisure to attend to the second ; and her feel- 
 ings for her own child, will, most probably, tempt her to an un- 
 fair division of the third. 
 
 618. It must, however, be acknowledged, that a Wet nurse has 
 in many instances a hard duty to perform. She is narrowly 
 watched in every movement and in every act ; she is sometimes 
 forced to endure the caprice, the revilings, and censures of a 
 wayward and over-fastidious parent — forced to swallow food 
 she loathes; deprived of that to which she has been accustomed, 
 
THIRD MEANS. 191 
 
 which she had always found to agree with her — but should the 
 child be ill, it is owing to her neglect ; if in pain, to the impro- 
 per indulgence of her appetite. And when the time of her pro--, 
 bation has nearly expired, pains are taken to alienate the affec- 
 tions of her charge from her, that the self-love of the mother 
 need not be too severely wounded — she is, perhaps, for a time, 
 even forbidden a house she has left with a sincere regret, be- 
 cause she bore a strong love for the child she fostered. And, 
 though we consider the child's exclusive love of the nurse as one 
 of the evils attending their employment, yet we should be sorry 
 to see the faithful discharge of duties rewarded in this way. 
 
 619. Did the evil stop here, it would not be so great; but 
 this conduct, as Rousseau justly observes, " instead of making an 
 affectionate son of an unnatural nurse child, she only excites his 
 ingratitude, and teaches him one day to despise her who gave him 
 life, as he already despises her who nursed him with her milk." 
 
 620. Hitherto, we have said nothing upon the subject of 
 drinks for the child during the period we have been conducting 
 our inquiries; having reserved its consideration until now, as a 
 very few words will be sufficient upon this head, though much 
 error prevails on it. It is a practice with many,, and especially 
 with people in the lower walks of life, to commence at a very 
 early period of the child's life, to give it a variety of drinks, 
 composed of ardent or fermented liquors; urging, in defence of 
 the practice, that " children should become accustomed to eat 
 and drink every thing." 
 
 621. We have witnessed, very often, with sorrow, parents 
 giving to their young children wine, or other stimulating liquors: 
 nature never intended any thing stronger than water, to be the 
 drink for children — this they enjoy greatly: and much advantage 
 is occasionally experienced from its use; especially after chil- 
 dren have commenced the use of animal food. 
 
 622. In the western parts of our state, where ardent spirit has 
 become almost the substitute for water, whisky is given daily in 
 large quantities, from the youngest to the oldest child; and, so 
 quickly do they become accustomed to this pernicious liquor, 
 that we have seen a child of six or seven years old, drink a 
 wine-glassfull at a draught. The consequence of such a prac- 
 tice can but too easily be foreseen. The directions for the use 
 of drinks, then, can be summed up in a very few words — name- 
 
192 OF WEANING. 
 
 ly, that nothing but pure water should be given to healthy chil- 
 dren. If they be diseased, they come under the direction of the 
 physician; and his province should never be usurped. 
 
 023.- We have often noticed with how much pleasure even 
 very young children take from time to time small quantities of 
 cold water ; and we believe there can be no good reason assigned 
 for withholding its occasional use, though we confess we are at 
 a- loss to account for its great success in curing belly-ache, as 
 many good old ladies tell us it does. We think we have seen 
 it very frequently interrupt hiccough ; and we have every rea- 
 son to believe it to be both innocent and grateful to the little 
 creatures, especially during the painful and feverish process, of 
 teething. v 
 
 CHAPTER VII. 
 SECOND PERIOD—OF WEANING. 
 
 624,- When the child arrives at a certain age, it is, generally, 
 taken from the breast; and that separation is called " weaning." 
 This, to an affectionate mother, is a period as full of solicitude^ 
 as of pain ; and it is consented to with a reluctance, that declares 
 the pleasure the act of .suckling had procured, as well as betrays 
 anticipations of dangers, which may too certainly await the 
 change. When weaning is determined upon, from the mere 
 age of the child, it is not at all surprising, that maternal solici- 
 tude should be powerfully awakened ; since this rule, if impli- 
 citly followed, must necessarily have its victims. The pro* 
 priety, therefore, of this separation, must depend upon several 
 circumstances, that it may not prove destructive or injurious 
 to the individuals concerned. These circumstances may be- 
 long— 1st, to the mother; 2dly, to the child; 3dly, to the season- 
 of the year. 
 
 Sect. I. — On the Part of the Mother. 
 
 625. There are various circumstances on the part of the mo« 
 
OF WEANIiVG. 193 
 
 ther, which may render it ineligible, or even improper, she should 
 continue to suckle her child — 1 st, she may be attacked with some 
 constitutional affection, which may so reduce her, as to make it 
 highly improper she should keep the child longer at the breast ; 
 she may be seized with some acute disease, which may require 
 repeated, and extensive depletion : so much so, indeed, as to 
 prevent the system from furnishing the proper quantity of food 
 necessary to nourish the child, yet sufficient to increase the de- 
 bility of the mother, and retard her convalescence. It may, also, 
 become necessary to keep the child from the breast, during the 
 very acute stages of fever; as the fatigue of suckling may do 
 much injury, by increasing the activity of the blood vessels. 
 
 626. In febrile affections of the mother, it may be proper, 
 however, to observe, that the child is never to be withheld from 
 the breast, under the apprehension that it may receive injury; 
 it is only to prevent, in such cases, the mother suffering from 
 fatigue. As regards the child, we feel the fullest confidence in 
 the truth of our observations, when we say, we have never wit- 
 nessed the smallest injury from permitting it to take the breast 
 under the most violent forms of fever.. In the yellow fever it- 
 self, we hfive a number of times witnessed its most perfect ex- 
 emption from injury, during the entire progress of this disease, 
 and even, indeed, to. its fatal termination. Therefore, as regards 
 the child, we repeat, its safety, we believe, is never menaced 
 from these causes. Yet, under such circumstances, it may be 
 highly important to the mother's safety, or necessary to her com- 
 fort, that the child be kept from her. And, should the child be 
 of a proper age, or in a proper condition for weaning, as we 
 shall indicate presently, it may be proper to do it at this time. 
 
 627. 2dly, The mother may be attacked with some local af- 
 fection that may render suckling extremely inconvenient, as well 
 as improper ; as milk abscess. In such case, the breasts may be 
 so inflamed, and the milk-vessels so impacted, that much injury 
 might be done by the attempt to suckle. Under such circum- 
 stances, all things being equal, it would be best to separate the 
 child. 
 
 628. 3dly, The supply of milk may be so diminished, even 
 without an evident cause, as to render it altogether insufficient 
 for the support of the child; consequently, both may be injured 
 by a perseverance. If this happen, it will be best, under proper 
 
 25 
 
194 OF WEANING. 
 
 circumstances, to wean the child. In a word, whenever any thing 
 decidedly injurious to the mother's health, is increased by suck- 
 ling, it should always be considered as a sufficient reason for se- 
 parating the child; or whenever any thing occurs on the part of 
 the mother, which so alters the quality of the milk, or so dimi- 
 nishes the quantity, as to render it improper or insufficient for 
 the support of the child, it should be regarded as a legitimate 
 reason for taking the child from the breast ; and if every thing 
 concur on the part of the child to render weaning proper, it 
 should be done immediately. 
 
 629. 4thly, The woman may become pregnant while suck- 
 ling; and this condition has ever been considered as a conclusive 
 reason for weaning, be the age of the child what it may. We 
 are, however, of opinion, that this notion has been too hastily 
 assumed ; or, at least, has been too generally acted upon. There 
 can be but two reasons why a pregnant woman should not suckle 
 her child — 1st, an alteration in the quality of the milk; and, 
 2dly, a great diminution of its quantity. But these reasons 
 would be valid upon any other occasion : therefore, the inquiry 
 should be, whether either, or both of these, necessarily take 
 place from pregnancy? We know of no absolute reason why 
 pregnancy, abstractedly considered, should render the milk of 
 the woman, who is giving suck, unfit for the purposes of the 
 child ; and, for this reason, we should be unwilling to test this 
 subject by argument, simply because the question should be de- 
 termined by facts alone. Now, these, so far as we have ob- 
 served, do not declare positively either one way or the other ; 
 for we have seen several instances where children were suckled 
 with impunity, until others were born ; and other cases, more 
 numerous, where children were weaned at the usual time, though 
 the mother was some distance advanced in her pregnancy, with- 
 out the smallest injury having been done to the children so cir- 
 cumstanced ; while others, again, were obliged to be taken from 
 the breast at a very early period, in consequence of the injuri- 
 ous effects of deteriorated milk. The rule, therefore, which 
 we have for many years observed, is, if the milk disagree, let 
 the child be separated; but, if it do not, let it be continued at 
 the breast, until the proper time of separation; or at least, un- 
 til some injurious effect manifests itself. 
 
 630, No possible injury can arise from this plan; for the 
 mother who may be thus circumstanced, will be upon an anx- 
 
OF WEANIiVG. 195 
 
 ious watch, for the moment of injury ; and, therefore, will, the 
 instant it is perceived, make other provision for her child. The 
 symptoms which may denote this state, are, on the part of the 
 mother, the diminution of the quantity of the milk ; and on the 
 part of the child, its altered quality ; the latter will declare it- 
 self, by being almost immediately rejected, and that in a state 
 of hard curd ; or in a thin semi-transparent condition, with a 
 peculiarly disagreeable smell. 
 
 Sect. II. — On the part of the Child. 
 
 631. When the child has arrived at the eleventh or twelfth 
 month of its age, it is generally thought to be sufficiently ad- 
 vanced to be taken from the breast. But it will immediately 
 strike any one of reflection, that the . rule formed upon the age 
 of the child, must be liable to many important exceptions. We 
 shall, therefore, consider this subject under two distinct heads ; 
 and these, subject to those variations which the season of the 
 year shall impose upon them. We shall, therefore, regard, 1st, 
 the state of the teeth ; and, 2dly, the state of the health of the 
 child. 
 
 a— Of the Teeth. 
 
 632. Nature evidently intended that the cutting of the teeth 
 should have some meaning as well as use ; and in our minds, 
 that meaning cannot well be mistaken, though she assumes 
 much variety in the period at which this may happen. That 
 the period of cutting the teeth is uncertain, is familiar to the 
 observation of every body ; yet, at whatever time this may 
 take place, the circumstance marks the condition of the stomach, 
 or of the digestive powers, in most cases, with much certainty. 
 Thus, if a healthy child* cut teeth at four months, it is more 
 than probable that its digestive powers would be as great as 
 those of a child that might not protrude them, until eight, or 
 even a more advanced period; therefore, if it be proper from 
 the circumstance of teeth appearing, to alter the nature of the 
 
 * We say, " if a healthy child cut teeth at four months," &.c, for we have seen 
 several instances of precocious dentition, in extremely debilitated constitutions — 
 such, therefore, then, must be regarded as exceptions to the rule. 
 
196 OF WEANING. 
 
 food of the child, it must be so at the early, as certainly as at 
 the later period. That nature intended that these little instru- 
 ments should be employed as soon as they make their appear- 
 ance, is rendered more than probable, by their coming almost 
 always through the lower jaw first. Jn this situation, they can 
 be called into immediate requisition, when necessary, which is 
 not the case, when they appear first in the upper jaw. 
 
 633. It would seem, then, that a child is capable of preparing 
 its more solid food, in proportion to the number of teeth it may 
 have cut; and that, precisely at the period at which they make 
 their appearance. Therefore, the number of the teeth more 
 
 .certainly points out the powers of the stomach, than the period 
 of the child's life at which they may thow themselves. In con- 
 firmation of this last remark, we may observe, that we have 
 almost constantly noticed, that children who are late in cutting 
 their teeth, neither seem to crave solid food more, nor digest 
 it better, than those who were much younger, but who were 
 supplied with an equal number of teeth. And, again, we may 
 remark, that the force of constitution is very well declared, by 
 the periods at which the teeth may be made to protrude through 
 the gums. 
 
 634. From these observations it will be evident, that the rule 
 founded exclusively upon the age of the child must be of very 
 doubtful application, if not injurious in its observance, since it 
 might sever a child from the breast at a time when its stomach 
 •was ill qualified to provide for the contingencies of the system. 
 We should, therefore, say that the presence of teeth is absolute- 
 ly necessary to the success of weaning, let the age of the child 
 be what it may; and, consequently,. that this should never be 
 undertaken until several are cut. 
 
 635. Dr. Struve recommends that such children as may be 
 suckled by a wet nurse, should be w r eaned as early as at six 
 months, lest their future affections be transferred from the mo- 
 ther to the nurse. We cannot see the propriety of this advice, 
 since, if the mother pursue the plan we have already laid down, 
 (610,) namely, to make the nurse the mere organ of nourish- 
 ment, there is but little danger of any permanent transfer of the 
 child's affections. Besides, it is unquestionably much too young, 
 at least in this country, for such a privation ; for the child, at this 
 period, has not a sufficient number of teeth to masticate its food, 
 
OF WEANING. 197 
 
 or, at least, sufficient to declare the stomach capable of digesting 
 it -, or this period may arrive at such time of the year, as we have 
 already observed would be inconvenient, or improper. Again ; 
 he urges, as an additional reason for this early separation, that, 
 J' the trouble attendant on weaning them is generally much 
 greater after six months, when their mental powers begin to ex- 
 pand, and the power of recollection daily increases, so that they 
 cannot, without great struggles, forget the foster mother, and her 
 breast." P. 229. This apprehension is altogether chimerical ; 
 at least, as far as regards any evil happening to the child. We 
 have often witnessed such separations; yet we have never 
 known any injury happen to the child, though they have not 
 been taken from the breast, until a much later period. But be 
 this as it may, the benefit of the child's bodily health should be 
 consulted, rather than this temporary affection of its mind. 
 
 636. Indeed, Dr. Struve, himself, furnishes a most conclusive 
 argument against his own plan, by declaring, that " if the teeth 
 should appear while these arrangements are taking place with re- 
 spect to a new system of diet, the child must, without hesitation, 
 be returned to the breast, till the first cutting of the teeth is ef- 
 fected by nature." P. 230. Is this not truly a work of super- 
 erogation? How seldom can it happen, that the child must not 
 be restored to the breast, if the period of six months be the age 
 for weaning, and the appearance of the teeth the contraindication 
 to this process? Does not this decidedly declare, that nature did 
 not intend this separation, until the child was in some degree pre- 
 pared for it by the appearance of these little instruments ? We 
 cannot hesitate a moment to believe this to be the case. 
 
 b— The State of the Child's Health. 
 
 637. It will, at first sight, be evident that the situation of the 
 child's health, must have a decided bearing on the propriety of 
 weaning, at the moment it may be proposed to be carried into 
 effect; for the child may be much reduced by previous illness, 
 or labouring under actual disease, so as to render this privation 
 highly injudicious. If in the former condition, no nourishment 
 at the moment, can be so proper, perhaps, as the mother's milk ; 
 or so certainly and freely conveyed, as by the mother's breast; 
 and when nourishment is all-important to the recovery of the 
 
]-98 OF WEANING. 
 
 child, as it very often is, it would be highly cruel, if not criminal, 
 to withhold the breast from it — therefore, weaning, as a matter 
 of choice, must not be thought of, at this time. For in the lat- 
 ter condition, breast milk may be the only nourishment proper 
 to give. If so, it should be retained for this useful purpose. 
 Besides, the experiment of taking away the breast while the 
 child is actually ill, has always been attended by bad conse- 
 quences, even where, at such times, it has spontaneously weaned 
 itself; therefore, it should never be attempted at that time, as a 
 matter of choice. . 
 
 Sect. III. — Of the Season of the Year. 
 
 638. It is a fact so w^ell knowm, that it scarcely requires men- 
 tion, that the period of the year will much influence a decision, 
 on the question of weaning. The season of the year may ren- 
 der this act convenient, inconvenient, or improper. 1st. The 
 convenient season of the year, will be all that period, when its 
 temperature is moderate; as the months of March, April, May, 
 June, October, or even early in November ; when the nights are 
 neither excessive in length, nor the atmosphere severe in tem- 
 perature. 2dly, It may be inconvenient from both these last 
 named causes; in the months of December, January, and Febru- 
 ary. 3dly, It may be improper, in case of diseases arising from, 
 or incident to a certain part of the year; being always aggra- 
 vated in newly weaned children ; as in the months of July, 
 August, and September. Therefore, weaning should be in part 
 regulated by these considerations. 
 
 639. When weaning has been determined on, and rendered 
 proper by the condition of the child, it will in a great measure 
 be prepared for this process beforehand, if it have been proper- 
 ly attended to, by having occasionally received other nutriment 
 than the mother's milk. The task is then, in part, performed ; 
 and the whole of the trial may be rendered less severe, by the 
 observance of the following rules : — 
 
 640. 1st, Accustom the child, from time to time, to take other 
 food than its mother's milk, by feeding it on bread and butter, 
 bread and milk, rice and milk, &c, or occasionally on beef, mut- 
 ton, chicken, or oyster tea; or, by giving small quantities of ei- 
 
OF WEAN I KG. 199 
 
 ther of these substances, in a solid form, as has already been di- 
 rected. 
 
 641. 2dly, Let the mother give the breast at longer intervals, 
 and gradually prevent its being the principal support of the 
 child. 
 
 642. 3dly. Let the child, after a little longer time, receive 
 the breast as seldom as possible. 
 
 643. 4thly, Endeavour to excite aversion to the breast, and 
 thus induce the child to withdraw itself from it, rather than 
 permit it to feel the want of it a privation. 
 
 644. 5thly, This aversion may be excited in,one of two ways 
 — either by touching the nipples with some bitter or disgusting 
 substance, as aloes, garlic, asafcetida, &c, or covering them 
 with a forbidding one, as black wool, ink, court-plaster, &c. 
 
 645. 6thly, When you commence this severe process, be firm ; 
 and let no importunity of the little pleader overcome your re- 
 solution, or your work will never be finished. 
 
 646. The process of weaning is much facilitated, by accus- 
 toming the child for some time to the use of vessels from which 
 it may drink any nourishing fluid, or even water at first. When 
 a cup or glass is presented to them, their curiosity is immedi- 
 ately excited, and they at once express their eagerness to pos- 
 sess it, by stretching out their arms, and seizing it with avidi- 
 ty; and no sooner are they in possession of it, than they carry 
 it to their mouths. By taking advantage of this early propen- 
 sity, children may be soon taught to receive food from almost 
 any vessel that may be offered to them. This- plan, however, 
 requires one caution — should the child have teeth both above 
 and below j it may be dangerous to trust them with vessels of 
 either glass or china — some metallic utensil will be much better. 
 
 647. A great error is generally committed, immediately after 
 weaning, by giving the child not only too much food, but that 
 of too gross and too solid a quality. This injurious practice has 
 arisen from the supposition that ^he child not only requires it, but 
 that it is certainly capable of digesting it. This plan of treating 
 children at this time is replete with mischief; and this mischief 
 is commensurate with the tenderness of the child's age, and the 
 solidity and grossness of the food exhibited. It injures the tone 
 6f the stomach, by overloading it ; and its digestive powers are 
 destroyed by the severity of the duty imposed upon them : in 
 
200 OF WEANING. 
 
 consequence of which, the child falls away, and becomes weak 
 in proportion as the plan is insisted on. If there be any latent 
 tendencies to scrofula, rickets, or consumption, they are now 
 actually developed, and the child falls a victim to the overwean- 
 ing desire of the mother, or its friends to promote its welfare. 
 
 648. Where milk will agree, there is no food so proper after 
 the child is taken from the breast. It may be employed in any 
 of its combinations, with good wheaten bread, rice, sago, &c, 
 only remembering, when either of these articles is found to 
 agree, it should be continued perseveringly, until it may become 
 offensive; in this case, some other combination maybe required. 
 Or, should the child be pretty well supplied with teeth, it may 
 be occasionally aided by small quantities of either of the animal 
 juices already mentioned ; but subject to the restrictions then 
 suggested. Struve recommends, on the authority of Hilde- 
 brandt, a soup made of the yelk of eggs and well-fermented 
 strong beer. As well as we can understand his limited direc- 
 tion, it is made in the following manner : two or three yelks of 
 eggs are well beaten together, and gradually added to a quart 
 of beer by briskly stirring it, to prevent curdling ; it is then to 
 be well boiled, and sweetened to the taste. Of this, the child 
 may take small portions, several times in the day. 
 
 649. It now and then occurs, that neither cow's milk, nor any 
 other, in its unaltered form, will sit upon the stomach of a child 
 when attempts have been made to rear it by artificial means. 
 When this happens, we have substituted, with great advantage, 
 gum Arabic, in -solution, in the proportion of an ounce to the 
 pint of water: to this must be added a little sugar, and as much 
 milk as will colour it, if the child be old enough to observe it. 
 Or, we have recourse to rennet whey, a little sweetened, and 
 disguised, if necessary, as just stated. When neither of these 
 succeeded, we have substituted the weak animal juice, as before 
 recommended. 
 
 650. Dr. Clarke* recommends, under such circumstances, 
 some farinaceous decoction, mixed with a little cream. Of this 
 we can say nothing from our own experience — nor are we aware 
 to what farinaceous substance he alludes, but suppose that either 
 sago, tapioca, or arrow root, might produce the desired effect. 
 
 * Commentaries, p. 57. 
 
OF TEETHIITG. 201 
 
 651. In the midst of our care for the child, we should not 
 forget that which may be necessary for the mother, or the nurse; 
 for if proper management be not made use of at this time, she 
 may suffer much from the swelling of her breasts. To prevent 
 this, it may be well, especially with one who has an abundance 
 of milk, that she begin to moderate it, as soon as she commences 
 with the preparative steps of weaning, by eating and drinking 
 less; and not having the child so frequently placed to the breast. 
 
 652. If these directions be duly attended to, the nurse will 
 not experience much inconvenience from accumulated milk. 
 But with a healthy woman, at whatever period almost she may 
 remove the child, there will be a painful distention of the breasts; 
 for the relief of which, let her observe the following precautions: 
 1st. After the child is separated, she should abstain as much as 
 possible from all fluid nourishment; eating nothing but the driest 
 food; as crackers, boiled rice, potatoes, boiled meats, or poultry. 
 2dly. Let her avoid all salted articles, as they will increase 
 thirst, and oblige her to drink. 3dly. Let her drink nothing 
 but pure water, and that in small quantities. 4thly. Let her 
 take a brisk dose of salts, if the pain in the breast be consider- 
 able ; and avoid exercise as much as possible. 5thly. If the 
 breasts be very much distended, and painful, rub them with a 
 little warm sweet oil, or fresh hog's lard. 6thly. Let the breasts 
 remain without drawing, as long as it may be supportable ; and 
 when drawn, let it be only in such quantity as shall remove the 
 distention. 7thly. Let the intervals of drawing be each time 
 longer. 
 
 CHAPTER VIII. 
 
 OF TEETHING. 
 
 653. In treating this subject, we do not think it necessary to 
 enter into minute anatomical descriptions of the first formation, 
 the progressive development, and successive changes which the 
 teeth undergo, before they are protruded through the gums ; we 
 
 26 
 
202 OF TEETHING. 
 
 shall, therefore, confine ourselves to a brief description of the 
 arrangement and order that nature pursues, in accomplishing 
 this important, and oftentimes hazardous process. 
 
 654. The teeth are formed, in part, in the foetus ; especially 
 the deciduous teeth. They are confined in distinct apartments, 
 or sockets; the first being placed above the second, or perma- 
 nent set. The first set consists of four incisors in each jaw; 
 two canini, or dog's teeth, and four grinders ; making twenty 
 altogether — that is, 
 
 8 Incisors, or cutter s ; 
 
 4 Canini, or dog teeth, or stomach, or eye teeth ; and 
 
 8 Molars, or grinders. 
 
 055. It is the teeth passing through the gums, that creates the 
 pain and disorders of teething, by stretching their investing 
 membranes ; or, in other words, the toath augments in size, 
 faster than the parts which enclose it are removed or absorbed. 
 The cutting of the first .set generally commences about the 
 sixth or seventh month, and ends between the second and third 
 years. These teeth are always smaller than the permanent set, 
 with the exception of the bicuspids, or small grinders. This is 
 a wise provision of nature, as the jaw enlarges, even to near 
 the adult age; consequently, as the jaws should have both their 
 circular portions filled, the teeth must be proportionally larger 
 as age advances. 
 
 656. The order of cutting, is, generally, as follows :— -first, 
 the two middle incisors of the lower jaw; then, after an interval 
 of three or four weeks, the corresponding upper incisors follow ; 
 but, frequently, the whole four appear in the upper jaw, before 
 the two lower ones are protruded. The two lower canine, one 
 on each side, now declare themselves ; and these are followed 
 by their corresponding teeth in the upper jaw. Soon after this, 
 the two first grinders, one on each side, succeed the canine in 
 the lower jaw ; those above then follow. 
 
 65>. After a lapse of from four to six years, four more grind- 
 ers are added to each jaw ; these are permanent. At the age 
 of twenty-one, four more teeth are given, and are called dentes 
 sapientiae, or wisdom teeth. 
 
 658. It must, however, be recollected, there are many re- 
 markable, as well as curious deviations from the order just re- 
 
 lated ; some of which it may be interesting to mention 
 
 m tne 
 to m( 
 
OF JEETHING. 203 
 
 659. 1. Sometimes children are born with teeth ready cut; 
 but this precocity is no proof of vigour of constitution.* 
 
 660. 2. Sometimes the lateral incisors cut themselves before 
 the middle ones ; at other times, the canine may be seen before 
 the incisors.f 
 
 661. 3. It is now and then observed, that the teeth are very 
 tardy in showing themselves. We have several times seen the 
 first tooth make its appearance after the fourteenth month ; and 
 Van Swieten mentions an instance, where this did not happen 
 until the eighteenth month, though the child was perfectly 
 healthy ;J and a child is now under our care, who has not yet 
 cut a tooth, though rather more than seventeen months old. 
 
 662. 4. Raver mentions a case, where the four canine teeth 
 did not show themselves until the child was thirteen years old. 
 This case was attended by severe headach, sore eyes, and con- 
 vulsions, for eight days previously to their appearance. § 
 
 663. 5. Fouchard relates an instance, where, at six years old, 
 the child had none but the fore teeth. || 
 
 664. 6. Brouzet gives an instance, where only one-half of the 
 proper number of teeth were present at the twelfth year of the 
 child's life ; and whose gums had acquired the hardness of an 
 old person's.11 
 
 * We have witnessed but two instances of children being- bom with teeth, 
 "We had the first opportunity in the year 1798, and the second in July, 1829. In 
 this case, there was but one tooth; but which, to this time, (July, 1830,) remains 
 fixed, and is still solitary. This tooth appears to have all the characters of a milk 
 tooth. There were two teeth in the first instance, and, being- the middle incisors 
 of the lower jaw, were very troublesome to the mother from their sharpness; and 
 very painful to the child, from their not being firmly set in the jaw; they could be 
 easily moved backward and forward, in consequence of which the gum became 
 irritated and inflamed. AVe cut them both out without the smallest difficulty, as 
 they had no roots, nor did they appear ever to have had — they were loosely 
 placed in the ridge of the gum. We do not believe these teeth were ever placed 
 in the alveoli of the jaw — they seem to be the product of the gum itself. 
 
 There are several instances upon record of this kind. Louis XIV. of France, 
 and Richard III. of England, are said to have been born with teeth. They do not 
 appear to be of the smallest use to the child; but are, on the contrary, perhaps, 
 mischievous. Children of this description are said to be less firm in constitution 
 than those who cut their teeth at the regular period — they generally die before 
 the third year. In one of the cases we witnessed, the child died in its fourteenth 
 month: the other is quite young. 
 
 f Diet. Scien. and jA. art. Dentition. 
 
 t Ibid. ^Rbid. !| Ibid. f Ibid, 
 
 and Med. 
 
204 OF TEETI^NG. 
 
 * 
 
 665. 7. Professor Baumes gives the history of a man who ne- 
 ver had any teeth to appear.* 
 
 066. At the time of birth, the teeth are lodged, as mentioned 
 above, in separate compartments ; the diciduous and permanent 
 ones having their respective stations within the cavity of the 
 jaw 7 bone, and placed over one another. Each tooth is, at first, 
 but a pulpy substance, and acquires hardness as the foetus be- 
 comes older ; the crown hardens first, the root then becomes os- 
 sified, and is hollow, that it may have transmitted into its sub- 
 stance, .blood vessels, and a filament of nerve.t 
 
 667. The whole tooth is surrounded by, a delicate, sensible, 
 and vascular membrane, which may be considered as its perios- 
 teum. This membrane is put upon the stretch — if not regular- 
 ly absorbed as the tooth increases ; (655) hence, the pain and 
 inflammation which so frequently accompany dentition; and 
 upon the division of this membrane depends the relief, so often 
 experienced, by incising the gums. 
 
 Sect. I. — Phenomena of Dentition. 
 
 668. 1st, One of the first signs observed in a child about to 
 cut a tooth, is heat in its mouth, which is distinctly perceived 
 by the delicate and sensible nipple of the mother. This heat 
 produces thirst, and makes the child demand the breast more 
 frequently than before. An itching, most probably, accompa- 
 nies this condition of the gum ; as the child, w T ith a view to re- 
 lieve it, seizes the nipple, and strips it frequently, by pressing its 
 little jaws close upon it : it also rubs its mouth with its fingers, 
 and presses upon every substance offered to its gums, however 
 hard that substance may be. In proportion as the child ac- 
 quires age before it cuts a tooth, is this disposition to press upon 
 any thing placed between its jaws ; hence, the mother is very 
 often made to suffer by severe pressure upon the nipple. 
 
 669.,2dly, A slavering, or a slight salivation, almost constant- 
 ly accompanies this condition of the gums, and seems intended 
 for four distinct purposes — first, to diminish by this discharge 
 the inflammation and irritation of the gums ; secondly, to mode- 
 
 * Diet. Scien. and Med. art. Dentition. 
 
 f Mr. John Hunter, however, says, he never could traolthe nerve distinctly, 
 even to the beginning" of the cavity. The nerves supplying the teeth are de- 
 rived from the second and third branches of the fifth pair. 
 
 trace the n 
 ) P lying the 
 air. ^ 
 
V OF TEETHING. 205 
 
 rate the thirst consequent upon this local inflammation, as the 
 child is observed to demand the breast less frequently after this 
 takes place ; thirdly, to supply an additional quantity of saliva, 
 with a view to assist digestion, as the stomach and bowels are 
 •apt to become disordered by too much food, or by its remaining 
 too long undigested : hence, children who slaver much are more 
 rarely affected with bowel complaints, than those who do not run 
 at the mouth ; fourthly, it serves as an evacuant, thereby abating 
 the general vigour of the arterial system, which too frequently 
 is roused into inordinate action, by the process of teething. 
 
 670. 3dly, After these symptoms have continued a longer or 
 .a shorter time, the gum is observed to become redder, a little 
 swelled, and immediately over the points at which the teeth 
 are about to issue, we may frequently observe in the lower jaw, 
 the parts to be semi-transparent ; these points are small cells, and 
 very often contain a little effused serum between the edges of 
 the teeth and the external covering of the gum. At these points, 
 we may also observe the little thread-like ridge to be effaced, 
 which mounts the centres of the gums, before any swelling takes 
 place, and the teeth soon after pierce the gum. 
 
 671. 4thly, The membrane lining the nostrils very often be- 
 comes sympathetically affected; hence, the frequent rubbing of 
 the nose, even to abrasion, sneezing, &c. 
 
 672. 5thly, Fever of a slight kind is very often provoked. 
 This shows itself, by heated palms; highly coloured, and often- 
 times offensive urine; flushing of the cheeks, frequently, how- 
 ever, but one at a time; great dryness of the lips, and heaviness 
 of the eyes. 
 
 673. 6thly, If several teeth are about to appear together; if 
 the absorption of the gums do not proceed regularly ; and if the 
 system be naturally irritable, we find the salivation either ex- 
 cessive, or nearly arrested ; the gums, too, become much swol- 
 len, very red, somewhat spongy, and extremely sensible ; fever, 
 even excessive at times; the kidneys furnishing much urine ; 
 leucorrhcea in females ; impatience, fretfulness, frightful dreams, 
 startings in sleep ; laughing, or whimpering while dozing ; diar- 
 rhoea, more or less violent ; swelling of the sub-maxillary glands ; 
 sore, or tender eyes,* and convulsions. 
 
 ast-nAd af 
 eyesJMpar 
 
 * The two last-nfl ■affections are easily accounted for, as the teeth, maxilla- 
 ry glands, and e^flHpart, derive their nerves from the fifth pair. 
 
206 OF TEETHING. #*• 
 
 674. Though these symptoms but too frequently accompany 
 the act of teething, they are by no means constant. We some- 
 times see them much more moderate than above described ; some 
 one or two only of these symptoms appearing together, and they 
 not alarming ; and, again, the whole of the teeth may make their 
 appearance so regularly, and silently, as not even to attract 
 notice. 
 
 675. The process by which the teeth appear above the gums, 
 or, as it is commonly called, " cutting of the teeth," is not gene- 
 rally well understood, especially by mothers. It is looked upon, 
 altogether, as a mechanical process; whereas, it is only partially 
 so. We shall, therefore, describe the manner in which this 
 takes place, as it is important that this process should be well 
 understood. 
 
 676. The teeth gradually enlarge within their respective 
 sockets. This increase is in three different directions — first, 
 upward, so as to press against the investing membrane and in- 
 cumbent gum, and thus induce their absorption— secondly, cir- 
 cularly, so as to impinge upon the edges of the sockets: this 
 pressure, when it becomes very strong, destroys the circulation 
 in the membrane which is fastened to the neck of the tooth, so 
 as to kill it, and thus occasion its absorption— thirdly, down- 
 ward ; but the depth to which the root sinks, is limited by the 
 under part of the jaw, 
 
 677. From these facts, it will be perceived, that the act of 
 cutting teeth is but in part mechanical; but that part is of great 
 consequence, since it gives rise to that important physiological 
 function called absorption. It is generally thought that the 
 teeth force their way through the resisting gum, but this is not 
 the case, in the strict meaning of the word forcing — for the 
 pressure of the tooth below, stimulates the absorbents to take 
 away the interposing membrane, and gum, that a passage may 
 thus be effected for it as it approaches the surface. 
 
 678. The belief, that the teeth force themselves mechanically 
 through the gums, gave rise to the practice of employing coral, 
 and other hard substances, to aid the operation. This practice 
 has been praised as rational by some, and condemned as inju- 
 rious by others. Those who have praised it, have done so upon 
 a wrong principle ; while those who have cj^emned it, have 
 done so with no better information. 
 
 679. Nature herself seems to call for thS «itice. This 
 
OF TEETHING. 207 
 
 seems to be proved by the disposition all children have to press 
 upon every thing hard or resisting that is presented to their 
 mouths, from the moment dentition begins, to its final accom- 
 plishment. It is but complying with an instinct, from which 
 they appear to derive both comfort and benefit ; and it is as con- 
 stantly obeyed, as the necessity is created. Is this desire to 
 press the gums upon every thing hard, a proof of the mechani- 
 cal nature of cutting teeth, as insisted upon by the advocates of 
 the coral, by presenting the part to be pierced between two re- 
 sisting substances? We think not : though we are advocates 
 for the employment of certain substances for the purpose of 
 pressure. 
 
 680. We are of opinion, that the following advantages are 
 derived, from indulging this instinct in children: Jst, it relieves 
 the pain or anguish of the tender gums, by pressing upon them, 
 as squeezing an inflamed finger, as in felons or whitloes, and in 
 many other instances ; 2dly, by gently stimulating the gums, 
 absorption is unquestionably promoted, and the teeth, in conse- 
 quence, more quickly appear ; 3dly, it seems constantly to pro- 
 mote the salivation, by which the engorged vessels of the mouth 
 relieve themselves. 
 
 681. The nature of the substance presented to the gums, as 
 well as its shape, are not. matters of perfect indifference, as it is 
 generally supposed. For instance, the coral, which is always 
 round and very hard, is improper, because the surface presented 
 to the gums, in consequence of this roundness, is very small, and 
 is thus calculated to do injury, by its partial pressure ; and, from 
 its extreme hardness, to bruise the gum. We do not object to 
 the coral, or other very hard substances, upon the principle ge- 
 nerally urged by those who condemn their use ; namely, " that 
 they harden the gums, and thus prevent the tooth from coming 
 through, or, at least, that it increases the difficulty of its pas- 
 sage;" for we do not believe they " harden the gums," as it is 
 called : but that they are calculated to bruise these parts, increase 
 their inflammation, and thus retard the process of absorption.* 
 
 * The process of dentition is one somelimes of difficulty among" savage na- 
 tions; as we are informed that among the Dacotas, " the children suffer much. 
 In such cases, the gum is never cut, but the children are allowed smooth stones, 
 and other hard subsidies, to rub against their gums." — Long's Second Expedi- 
 tion y Vol. I. p. 
 
 I subsjflbes 
 
 W 
 
208 OP TEETHING. 
 
 682. The substance offered to the gums for the purpose of 
 biting upon, may be of inferior hardness to the coral, ivory, &c. ; 
 such as a piece of orris root, or scraped liquorice root ; but 
 what is safer, a fiat ivory ring, or a piece of india rubber. The 
 rubbing of the gums with the finger, affords great relief when 
 they are much irritated ; and we constantly recommend this 
 pleasant application. But we decidedly disapprove of any such 
 substance as honey, powdered sugar-candy," &c, to be em- 
 ployed for this purpose, as they only serve to irritate the gums, 
 without farthering the object for which they are employed. 
 The shape of the substance on which the child is to bite, should 
 be nearly flat, and sufficiently broad, that it may present a large 
 surface to the gums : it should, also, be of the proper thickness. 
 
 683. There exists a diversity of opinion on the propriety of 
 aiding the protrusion of the teeth, by cutting through the swollen 
 gums. We are, however, of opinion, there should be but one, 
 and that should be in favour of the operation. We shall again 
 consider this subject, when treating of the diseases which may 
 accompany teething. See Diseases of Teething, Book II. 
 
 Sect. II. — Second Dentition. 
 
 684. At about the seventh year, the deciduous, or milk-teeth, 
 are replaced by others of a larger, and more permanent kind. 
 The first teeth are almost always very perishable, and rarely 
 last in a perfect state, until the jaws are supplied by the second 
 crop. They are very apt to decay, particularly with children 
 of feeble constitution, or who have been much afflicted by sick- 
 ness. The incisors are particularly liable to caries, especially 
 those in the upper jaw — they frequently turn black, and break 
 off close to the gum. The larger teeth are also disposed to ca- 
 ries, and often create much suffering by their decay. We have, 
 however, never observed these inconveniences to influence the 
 second cutting of teeth.* Indeed, sometimes, it would seem to 
 favour their growth, by offering less resistance to their passage. 
 
 685. Parents very frequently neglect their children's mouths, 
 at this period of life, to the serious disadvantage of their future 
 
 • This will be readily understood, when it is recollectejjflfcat each set is con- 
 tained in separate apartments. 
 
 rtedjfcat eac 
 
 m 
 
OF TEETHING. ZV'3 
 
 comfort, especially when the front upper teeth are labouring 
 under decay. Against this inattention we would wish to warn 
 .them, by recommending the removal of the stumps of teeth, 
 whenever they ache, or the gum becomes inflamed. If the 
 early stage of this inflammation be neglected, the coverings of 
 the teeth are almost sure to inflame, and run on to suppuration. 
 Gum-boils are formed, and the roots of the teeth find their way 
 through the gum, by the sockets being absorbed in which they 
 were confined — in consequence of this, the teeth, which are to. 
 follow receive an injury, for the want of due protection from 
 .the plate of hone in front of them, which was too suddenly re- 
 moved. It is, therefore, every way desirable and proper, that 
 they should be removed in good time by a skilful dentist. The 
 same observations will apply with equal propriety to any other 
 of the teeth that may be painful, or that may have the gum sur- 
 rounding them threatened by abscess. When the teeth are 
 much decayed, and the time is approaching for the appearance 
 of the permanent ones, the child's mouth should be examined, 
 or, rather, submitted to the judgment of the dentist. 
 
 68G. Before, however the time for the second cutting arrives,, 
 the child undergoes very considerable changes in its person. 
 This change happens generally after the second year ; that is,. 
 very soon after it has completed its first dentition. The jaws 
 are now observed to 'spread themselves, and to acquire an in- 
 crease of strength, since at this time they can break down with 
 the teeth pretty hard substances. 
 
 687. The fontanelies are generally closed, or, rather, the soft 
 cartilage with which they were before covered, is now convert- 
 ed into bone of greater or less hardness. The limbs acquire ar* 
 increase of power, and the child walks with more firmness and 
 assurance. The abdomen loses its roundness, and becomes 
 more flattened. 
 
 G-S8. The face becomes more expressive, the eyes acquire 
 more intelligence, and the whole features of the child are better 
 developed : this is particularly the case with the nose, which 
 now assumes its permanent form. The chin becomes rounder, 
 and gives more freedom to the teeth within. The internal viscera 
 augment with the other portions of the body; and the senses be- 
 come more accurate in their several discriminations. The tongue 
 praduRlly givp> uArance towords; and they qaiekly acquire the 
 
 27 
 
210 OF TEETHING. 
 
 power of expressing their little wants. They thus obviously 
 improve until the seventh year; at this time, the first teeth gra- 
 dually drop out, to give place to another set — this operation is. 
 called shedding the teeth. 
 
 089. We have already observed, that the first teeth are but 
 twenty in number ; these are now replaced by twenty -four. At 
 about the twelfth or fourteenth year, four more are added; and 
 the teeth of wisdom follow, at from the eighteenth to the thir- 
 tieth year. 
 
 690. We have also observed, that it is commonly supposed the 
 first set of teeth are pushed out mechanically, by the second 
 rising under them ; but this is not the case, for the following rea- 
 sons. — 1st, because the first and second set are not contained in 
 the same cavities or sockets, nor are they immediately opposed 
 to each other by situation ; 2dly, because the first set does not 
 rise in proportion to the advance of the second, which would be 
 the case were they lifted from their position by the second set ; 
 3dly, because there is a destruction of the sockets of the first 
 teeth, while those of the second remain perfect, and increase in 
 size ; 4thly, because some of the first set fall out, when there are 
 no second ones under them ; 5thly, because the roots of the first 
 set are almost always observed to be removed by absorption, 
 so that the teeth are now only fixed by their necks to the gum, 
 and can be easily moved in any direction ; or have become loose. 
 
 691 . The reason for shedding the teeth, must be obvious to any 
 one, who will give the subject due consideration. In the infant, 
 the jaw is so small, when compared" even with that of a child of 
 seven years, that much inconvenience would be experienced, did 
 not larger, and a greater number of new teeth supply the place 
 of the first; & fortiori, the inconvenience would be greater in the 
 adult, did not these useful little instruments occupy a larger 
 space. For, were the grinders of the child to be the last to be 
 provided, they would, by the growth of the jaw in adult age, be 
 thrown so much in advance as to be almost useless, by being 
 removed from the centre of motion. 
 
 692. From what has been said, it will be evident, that the 
 first and second sets of teeth are pretty independent of each 
 other ; that is, the condition of the first set has little or no con- 
 trol over the second, and the reverse. 
 
 693. The order in which the second s«kppears, is pretty 
 
 ;adkppe 
 
OF THE TOOD PROPER FOR CHILDREN, &C. 211 
 
 nearly the same as that of the first — the incisors first show them- 
 selves, and are oftentimes much larger than those of the first set, 
 but the first permanent grinders do not usually appear until 
 about the twelfth year, the second about the eighteenth, and the 
 teeth of wisdom from the twentieth to the thirtieth year, as has 
 been already noticed. So that the incisors, and the cuspidati, 
 require about six or seven years from their first, appearance, to 
 arrive at perfection; the bicuspids, about seven or eight; and 
 the molars, about twelve. 
 
 694. The increase of size, and the augmented number of the 
 second teeth, sometimes do not find sufficient room in the jaws, 
 to arrange themselves in regular order. When this happens, 
 some of the teeth are obliged to be extracted — but this is the 
 business of the dentist. 
 
 CHAPTER IX. 
 
 OF THE FOOD PROPER FOR CHILDREN, AFTER THE 
 FIRST DENTITION, AND WEANING. 
 
 695. It must not be imagined, that every kind of food is pro- 
 per, after the child has completed its first dentition. For, though 
 this important change has been successfully accomplished, still, 
 the digestive organs require that only such substances shall be 
 offered, as can be completely and readily subdued by the still 
 feeble teeth. It would, on this account, be highly injurious to 
 feed the child upon such food as would require great powers of 
 mastication, as it would neither have strength nor patience to 
 reduce it to sufficiently small particles ; it would, therefore, be 
 at the risk of choking, swallowing it whole, or having it con- 
 veyed into the stomach, very imperfectly chewed. 
 
 696. The stomach would thus receive food not adapted to its 
 powers, and, of course, would suffer by its being improperly 
 taxed. But it is not the quality of the food, alone, that is to be 
 attended to when a change is contemplated — we should be par- 
 ticularly careful that this change be not made too suddenly. 
 
212 OF THE FOOD PROPER FOR CHILDREN, 
 
 The stomach, during almost every period of life, seems to ac- 
 quire, from habit, a power over substances of even an indigesti- 
 ble kind; and is capable of converting them into proper nourish- 
 ment, when, perhaps, it might fail in subduing some other, which, 
 generally-, is of more easy solution. Therefore, a part of the 
 food, at least, that was given during suckling, may be continued 
 with much propriety after weaning. 
 
 697. It must, however, be recollected, that an additional quan- 
 tity will be required, since the child now loses a part of its for- 
 mer sustenance, by the abstraction of the mother's milk. This 
 may be accomplished in one of two ways : first, by increasing 
 the number of meals ; or, secondly, by augmenting the quantity 
 at a meal. The last method is preferable, since it permits a 
 longer interval for the digestion of the quantity previously taken'; 
 for, as we have already observed, the process of assimilation 
 should not be interrupted, when it can be avoided, by additional 
 quantities of food being poured into the stomach. 
 
 698. On this account, it is always important to establish regu- 
 larity in meals ; but, for the child newly weaned, the periods, 
 which were formerly observed in suckling, may, for awhile, be 
 retained ; taking care to prolong the intervals gradually, that 
 they may, after a time, be reduced to an orderly series. We 
 would not wish, however, to lay down absolute rules for this 
 purpose, since the intervals must in a great measure be contin- 
 gent upon the powers of the stomach itself; and these must ne- 
 cessarily vary in different children : some digesting much more 
 rapidly than others, owing to the original healthiness of this or- 
 gan, or to circumstances connected with air and exercise. Thus, 
 children running about in the pure air of the country, will di- 
 gest their food more rapidly than those confined within the walls 
 of the nursery; and who breathe the less pure air of the city. 
 
 699. There is, perhaps, no period of the child's life, in which so 
 much care is required, to avoid overtaxing the powers of the sto- 
 mach. It is at this time, particularly, that the foundation of a weak 
 stomach is laid, by giving too much food * even of a good quality ; 
 hut, more frequently, by indulging children in such articles as 
 their little stomachs cannot master. Many parents are of opinion, 
 that children should be indulged in whatever they fancy — be- 
 lieving, most erroneously, that this organ never craves that which 
 would be hurtful to it. Hence, the preposterous and injurious 
 
AFTER THE FIRST DEXTITIOX. 213 
 
 farrago -with which children are sometimes crammed; and hence 
 indigestion, with all its terrible consequences. 
 
 700. The food of children cannot well, at this period, he too 
 simple. A great mixture is bad, in every stage of life; but is 
 particularly injurious in infancy, and in childhood. The various 
 jellies from vegetable substances, at this time, are very proper-* 
 such as fee jellies of tapioca, rice, sago, or arrow root ; these 
 may be taken with fresh milk, with the most decided propriety 
 and advantage, since they are void of all stimulus, and are of 
 easy assimilation. The quantity of these, however, must be re- 
 gulated by the good sense and discretion of the parent, rather 
 than by the appetite of the child ; for this may be naturally in- 
 ordinate ; or artificially so, by ill-judged indulgence. 
 
 701. During the period of dentition, the system is almost al- 
 ways in a highly excitable state, and is but too readily roused 
 into fever; therefore, nothing can be more decidedly preposte- 
 rous and destructive, than allowing children to live upon stimu- 
 lating articles of food ; yet nothing is more common. Parents 
 cannot always resist the importunities of their children, though 
 'their better sense at the moment condemns the indulgence ; and 
 thus a habit of importunity is created, and in a short period they 
 permit themselves to be governed ; and the children in conse- 
 quence are rendered miserable, by a compliance with their ar- 
 tificial wants. 
 
 702. It requires only a little firmness in the beginning, and 
 that not of very long continuance, to make children conform to 
 the dictates of their parents, and to render them entirely obe- 
 dient to their wills ; for it is only necessary to commence suffi- 
 ciently early, to make the child know it is not to think for itself. 
 Neither its palate, nor its caprice, is to be consulted— the parent 
 must set before it, for its meals, such articles of food as are 
 judged best for it ; and it is to be made to understand, that it 
 must eat them, or nothing. If this plan be followed for a short 
 time, all trouble will cease ; since, as the child has never had a 
 wish respecting its food gratified at the expense of propriety, it 
 will soon cease to have any; or rather, it will never have any to 
 arise. But if the parent be weak enough to consult the child's 
 taste at table, it will soon demand a portion of every dish, nor 
 be satisfied until it obtain it. We need not say, how subversive 
 this conduct would be of all order, and propriety; or howseri- 
 
214 OF THE FOOD PROPER FOR CHILDREN, 
 
 ously, nay, oftentimes, how irreparably the child may be injured 
 by it. 
 
 703. We must not, however, be understood to prohibit all in- 
 dulgence to a -child at table ; on the contrary, we would wish to 
 make them feel, every now and then, that we were doing them 
 a favour, by occasionally departing from our general rule; 
 taking care at the same time, however, that we give nothing 
 injurious to the stomach. By this plan, they will perceive their 
 dependence ; and also make them grateful for the occasional in- 
 dulgences they experience. 
 
 704. This mode of treating children, has many decided ad- 
 vantages over that of a compliance with the indiscriminate, and 
 oftentimes injurious demands they make at table. Their moral, 
 as well as physical powers are benefited by not yielding to their 
 importunities ; for if these be once complied with, there is an 
 end to all future subordination — all control ceases, and health 
 suffers almost in proportion to indulgence. How often does it 
 become essential to confine children to a specific diet ! But how 
 can this be effected, if they have been permitted to select their 
 articles of food? Let any parents who have allowed their 
 children to eat indiscriminately of any or every article at table, 
 answer, whether it does not constitute one of their most difficult 
 tasks, to withhold from them the prohibited articles, when they 
 become sick? Our experience declares it to be a common ac- 
 knowledgment, that it is next to an impossibility to do so, how- 
 ever imperious the necessity for such denial may be. Yet all 
 this trouble might have been spared, if a proper system had 
 been in due time adopted. 
 
 705. It is not necessary to confine children always to the same 
 form of food ; this may be occasionally varied with advantage; 
 especially if it be perceived that their appetites flag a little 
 from the long continuance of one kind. Thus, milk, which 
 should constitute the chief article of diet of children until after 
 complete teething, may be given in a variety o£ very acceptable 
 forms; such as milk and bread boiled or unboiled; rice and milk, 
 sago and milk, arrow-root and milk, &c. Plain rice pudding is 
 a very acceptable dish to almost all children, and may be occa- 
 sionally introduced as a "bonne bouche" with great advantage. 
 
 706. We do not hesitate, also, to indulge children, now and 
 then, with small quantities of animal food, especially after they 
 
AFTER THE FIRST DENTITION. 215 
 
 have their first teeth complete. But animal food should not 
 constitute their principal support even at this time, since it may- 
 overtax the stomach, and too much excite the system ; and be- 
 fore this time, it should be most sparingly indulged in, though 
 not altogether withheld, for the reasons assigned above. 
 
 707. The drink of children should be pure water, or occa- 
 sionally, milk and water.* There can be no possible propriety 
 in giving them liquors of any sort whatever ; for unless as a 
 remedy in disease, the system never requires them ; and when 
 indulged in without a necessity, are sure to do mischief. But 
 children should not be permitted to acquire a habit of drinking 
 very often; for it will certainly be mischievous, by over-dis- 
 tending the stomach, too much diluting the gastric juices, and 
 impairing the appetite. During their meals, a moderate quan- 
 tity should be given to them, as it will then be useful, by form- 
 ing a more complete pulp of the food taken in, and thus sub- 
 serve the purposes of digestion. The water given to children 
 should not be of too low a temperature, lest it give pain, and do 
 injury to the powers of the stomach. We think we have seen 
 serious injury result from the too free use of iced water. 
 
 708. It will readily be perceived, that after the child has com- 
 pleted his first dentition, he may be permitted, by a gradual 
 change, to eat food of a more nutritive kind — or, in other words, 
 more animal food. But in permitting this,, a proper regard 
 should be paid, first, to the kinds of animal food; secondly, to 
 the mode of preparing it; thirdly, to the period of the day at 
 which it is taken ; and, fourthly, to the quantity employed. 
 
 709. 1. Of the kinds of Animal Food. — It must not be assumed 
 with too much facility, that even a moderate quantity of any 
 kind of animal food is equally proper. It is no longer a matter 
 of conjecture, but one of very often repeated experiment, that 
 there is much difference in the degree of solubility, if we may so 
 term it, of animal foods; and that, which from long observation 
 has proved to be the most easy of digestion, should be the one 
 generally preferred. On this account, beef, mutton, lamb, veni- 
 son, fowls, turkeys, pheasants, partridges, &c, are to be pre- 
 
 * We have found weak molasses and water not only a very acceptable drink, 
 but a valuable one to such as have a tendency to constipation; children, therefore, 
 may be occasionally indulged with it as a pleasant beverage, as well as a very* 
 mild and certain laxative, 
 
216 OF THE FOOD PROPER. FOR CHILDREN, 
 
 ■ferred to veal, pork, pig, geese, and ducks; since it has been 
 proved by almost universal experience, that the stomach assimi- 
 lates the former more easily. We are aware that this is not 
 universally the case ; but the exceptions only prove the rule. 
 Therefore, when a child is at the age proper for indulgence in 
 a portion of animal food, one of the first class enumerated 
 should be employed. 
 
 710. Veal and pork are particularly unfriendly to the young 
 and unconfirmed stomach; and should, therefore, never be se- 
 lected for the diet of such children. We have known numerous 
 instances of both these substances remaining undigested in the 
 stomach for four and twenty hours, and sometimes, even longer, 
 and then thrown up, after having tortured the poor child w T ith 
 pain, fever, or colic, for several hours. The flesh of ducks and 
 geese is nearly as bad as veal or pork, but not altogether so; 
 especially if care be taken to separate the skin from the flesh. 
 
 711. Fresh fish, boiled, of almost every kind, sits well upon 
 the stomachs of children, when taken in moderate quantities, 
 and at proper periods of the day; and even salt fish, in very 
 small proportions, is sometimes very acceptable. 
 
 712. Eggs, when not boiled hard, are easily assimilated by 
 most stomachs: they rarely disagree when fresh; and when 
 given in moderate proportions, especially in the morning, are 
 highly nutritious. Nay, they sometimes form a valuable arti- 
 cle of food, when beaten up with sweetened water, or <milk and 
 water, during convalescence. 
 
 713. Salted meats of every kind, are of much more difficult 
 digestion than fresh, if we except pork. Ham is less injurious 
 than the fresh pork; but salted beef, salted venison, and dried 
 mutton, are of more difficult solution than when fresh. 
 
 714. 2. The mode of preparing it. — It is a matter of great im- 
 portance, that meats of every kind, should be properly prepared 
 r or cooked ; for if this be not attended to, the most wholesome 
 may be converted into a temporary poison, by being rendered 
 literally indigestible. For young children, plainly boiled and 
 roasted are the best; and these should be sufficiently done; or, 
 in other words, not too rare, Poultry, and fish, should always 
 be thoroughly well roasted, or boiled; but the roasting should 
 not be carried to the dissipation of all moisture— nor the boiling 
 to the falling to pieces of the article. 
 
AFTER THE FIRST DENTITION. 217 
 
 715. Game and poultry may be treated after the same man- 
 Tier — either roasted or boiled, in.a due degree. Some, however, 
 are of opinion, that beef, mutton, lamb, or venison, cannot well - 
 be too little done — hence many have these articles brought raw 
 to the table, sometimes to undergo a second process; while 
 others go to the opposite extreme. We think the proper degree 
 lies between these extremes. It is pretty generally agreed, 
 that poultry, and certain game, as the pheasant and partridge, 
 should be well done ; if from among the poultry, we except 
 ducks— - the latter are generally preferred under-done. This, 
 unquestionably, improves their flavour ; but we are not certain 
 that it is any advantage to the stomach. 
 
 716. Fried, stewed, or highly seasoned meats, are always im- 
 proper for children; veal-cutlets, stewed veal, fricasees, or ra- 
 gouts, are always injurious, and should ever be avoided. The 
 same may be said of every kind of meat pies. Broiled meats 
 are less injurious than fried ; especially beef, mutton or venison. 
 Poultry, treated after the same manner, is less healthful, and 
 should not be as freely given as when roasted or boiled. 
 
 717. 3. The Period of the Bay. — It is very far from being a 
 matter of indifference, at what period of the day the child re- 
 ceives animal food. Of so much consequence is this, sometimes, 
 that the same article may be either proper or injurious, as it may 
 be given at one time or another. Therefore, as a general rule, a 
 rule, indeed, admitting of but few exceptions, animal food should 
 be taken only in the morning, or at noon \ and, as another gene- 
 ral rule, we should much prefer the latter, for the following rea- 
 sons: 1st. The child, in the morning, from the previous night's 
 rest, has its system rendered very excitable at that time : there- 
 fore, it should be confined to bread and milk, weak tea or coffee,* 
 and bread and butter, mush, boiled rice, or any other mild food. 
 2dly, From the appetite at this time being rendered very keen, 
 there is a risk that it will take too much, if animal food be 
 added. At noon, the excitability of the system is a little worn 
 down by exercise, &c. ; and at this time, the stimulus of a mode- 
 
 * We mention weak tea or coffee from necessity, and not choice. In our large 
 cities, it is not always easy to command the more suitable article, milk. But any 
 injurious qualities appertaining- to either tea or coffee, may easily be counter- 
 acted; or, rather, they may be so diluted, by'the liberal addition of milk or water, 
 as not to be hurtful, 
 
 28 
 
218 OF THE FOOD PROPER FOR CHILDREN, 
 
 rate quantity of animal matter, may not only safely, but profi- 
 tably be indulged in. In the evening we would forbid it ; as di- 
 gestion will not be completed before the child goes to bed, and 
 it may have its sleep much disturbed in consequence ; or, it may 
 sleep too soundly, from the stomach being oppressed by an over 
 quantity of food, or by the blood vessels becoming too much 
 filled. 
 
 718. 4. The Quantity emptoyed. — Children should, never 
 make animal substances a principal part of their food, until af- 
 ter the age of puberty. Before this period, there should be a 
 predominance of either vegetables or milk. The vegetables, 
 however, should be properly selected, and but one kind should 
 be used at a time ; as mixtures of them are always less manage- 
 able by the stomach, than when they are presented singly. The 
 best vegetables are rice, potato,, spinach, asparagus, turnip, and 
 squash — the less proper are, beans of every kind; cabbage, beets 
 cooked with vinegar, peas, sorrel, and cucumbers. Animal 
 substances must be used but in moderate quantities, especially 
 with children who go to school ; for if it be made the principal 
 part of the diet of such children, they are sure to be over-sti- 
 mulated ; th%y become sluggish and drowsy, and thus incapa- 
 citated for study. Those children who make milk the princi- 
 pal part of their diet, are always found to be the best students. 
 The fatigue of study is much diminished by employing a mild, 
 nutritious diet; since by this regimen, the faculties become more 
 acute, and the memory is strengthened. 
 
 719. We may then consider it proper to employ a moderate 
 quantity of animal food after teething, and the quantity may be 
 gradually increased until the age of puberty. Of the period sub- 
 sequent to this, we have at present nothing to say. 
 
 720. In regulating the diet of children, care should be taken 
 not to force any particular substance upon them, after it has been 
 found by fair and repeated trials to disagree. There is both 
 cruelty and bad judgment in doing so. It is cruel, because the 
 .poor child is forced to swallow that which is disagreeable to it ; 
 and bad judgment, because it is perpetuating a disgust, which, 
 •most probably, would have subsided, had it been let alone — for 
 the stomach will oftentimes forget injuries, if not reminded of 
 them by repetition. 
 
 721. Great dtire, however, must be taken at this period of life. 
 
AFTER THE FIRST DENTITIOX. % 219 
 
 that permanent dislikes are not formed against certain articles 
 of food. Temporary disgusts are frequently experienced ; and t if 
 not counteracted, may degenerate into inveterate aversion, to 
 the great discomfort of the individual. The management of this 
 case is frequently a point of great nicety; for it requires a good 
 deal of close observation, and discernment, to distinguish be- 
 tween a wayward prejudice, and an actual disgust. The for- 
 mer, if indulged in too long, may be converted into the latter, 
 and the latter may oftentimes, by judicious and well adapted 
 means, be entirely removed. 
 
 722. Waywardness, or prejudice, should not be yielded to — 
 a little well-directed firmness is almost sure to overcome it. It 
 is always best managed by reasoning ; by representing the in- 
 conveniences, and sometimes disagreeable consequences, which 
 may arise from indulging in such feelings ; and by persuading 
 them, they would soon become reconciled to the article, if they 
 were to make proper trials to become so. 
 
 723. Real aversion arises from a particular feeling of the sto- 
 mach itself, and which is not always under the control of rea- 
 son, however strongly exerted. This condition may arise from 
 a natural and inherent dislike to certain articles of food, the 
 origin of which cannot be traced ; nor can its cause be ascer- 
 tained. One of the most frequent of this kind is that to mut- 
 ton. Or, it may arise from some accidental circumstance, as 
 taking too much of any certain article ; to this not being in a 
 perfect state ; or from its being imperfectly cooked — nausea and 
 vomiting are excited, and the stomach becomes irreconcilable 
 to its presence, ever after. 
 
 724. The cure of either of these conditions of the stomach, 
 requires much perseverance and determination — it should al- 
 ways, however, be attempted. The best plan, we believe, (at 
 least it proved so in our own case,) is, first, to make the object 
 endurable to the eye, by viewing it steadily and frequently, for 
 some time : if this be persevered in, with a determination to con- 
 quer, it will be found that the object will gradually lose its an- 
 noying force. Afterwards, the eye becomes familiarized to its 
 presence, or can look upon it with indifference — this is a great 
 point gained. The next step is to accustom the nose to bear its 
 effluvium without repugnance, when it is near you, at table: when 
 this can be supported, the cure is near at hand; for the stomach 
 
220 OF SUBSTANCES HURTFUL TO CHILDREN, 
 
 is much influenced by the eye and the nose. The taste is next 
 to be reconciled — this is best done at a time when strongly 
 urged by hunger. Small quantities may be given at a time : 
 should the stomach not now revolt, it may be swallowed with 
 impunity. This must be occasionally repeated, until the aver- 
 sion is overcome. 
 
 CHAPTER X. 
 
 ARE THERE SUBSTANCES IN COMMON USE, ABSO- 
 LUTELY HURTFUL TO CHILDREN? 
 
 725. This question is very often asked, and is almost as vari- 
 ously answered. This arises frequently from the fondness or dis- 
 like people may have for certain substances, rather than from 
 absolute experience; believing the substance of which they 
 themselves are fond, to be always innocent, and that to which 
 they have aversion, or which may have accidentally disagreed, 
 to be always injurious. To those who are able to judge for 
 themselves, we shall offer no observations upon the various ar- 
 ticles of diet constantly presented to them — they must be regu- 
 lated by their own experience; for, if this will not render them 
 judicious in their choice, they must submit to the penalties at- 
 tached to voluntary error. 
 
 726. Not so, however, is our determination with respect to 
 children, for whose health we profess to be sincerely anxious, 
 and are desirous to promote by every means in our power. We 
 shall, therefore, offer a few observations upon various substances 
 In common use, and of which children are almost constantly 
 made partakers. 
 
 727. There cannot be a more absurd question, than, " Is such 
 a thing wholesome?" since, to be answered safely, requires so 
 many considerations, and so many exceptions, that no one should 
 venture to answer it either affirmatively or negatively, before 
 duly weighing them. Whenever the late Dr. Cullen was asked 
 this question, he inquired of the speaker, " Does it agree with 
 
OF SUBSTANCES HURTFUL TO CHILDREN. 221 
 
 you V If answered in the affirmative, he would declare it to be 
 wholesome. This, for a person who has experienced the effects 
 of an article, is a most judicious answer; but to the child who 
 has no such experience, such answer cannot apply. With a 
 view, therefore, to aid the choice, we shall consider the subject 
 a little in detail, and endeavour to fix some general principles, 
 founded upon the influence of various substances upon the ten- 
 der and unconfirmed stomachs of children. We shall, there- 
 fore, lay down certain data, and reason from them as this may 
 become necessary. 
 
 728. 1. That nature never intended that children who have 
 no teeth should be nourished by precisely the same aliment, as 
 those who have, and the reverse. Therefore, the food that may 
 be proper for one, might be decidedly injurious to the other ; 
 consequently, animal food, pastry, fruit, confectionary, &c, 
 would be positively injurious to the child without teeth- Yet 
 neither of these substances, under proper circumstances, and in 
 proper quantities, should be considered as positively hurtful, 
 since they are only so quo ad hoc. 
 
 729. 2. The food which may be proper after dentition is com- 
 pleted, may be highly injurious while this process is going on ; 
 hence, animal food, or any other stimulating article of diet, may 
 be looked upon as positively injurious— though it be only for a 
 limited period. 
 
 730. 3. The food for adult age, if employed before puberty, 
 would often be found highly injurious ; though the general expe- 
 rience of the world would deny their being positively hurtful in 
 themselves. 
 
 731. 4. The food which universal experience may declare to 
 be " wholesome," can only be so, when taken in proper quantities, 
 at proper periods, and under proper circumstances; therefore, 
 any substance, in undue quantity, and at an improper season, 
 may become hurtful; but must not be declared positively injuri- 
 ous, in a general sense. Consequently, when we speak of food, 
 on which thousands have lived and did well, or from vyhich 
 others have suffered, being either wholesome, or unwholsome^ 
 we must mean it is either the one or the other, according to the 
 age and constitution; to the particular circumstances under 
 which the body may be placed, as climate, sickness or health; 
 or to the quantity, or particular quality of the articles in question. 
 
222 OF FRESH FRUIT. 
 
 732. It must not, however, be inferred from what has been 
 said, that we consider every article of diet equally proper — far 
 from this : for though we do not admit that any of the usual 
 articles of food are positively hurtful in themselves; yet we de- 
 clare, it will always be proper to make a choice from them; 
 and on that choice will very much depend the proper hdklth of 
 the individual who may employ them. Thus, we have already 
 declared, that the meat of one animal is better than that of ano- 
 ther ; and so of many other substances. Yet, the best of either 
 of these articles may be highly pernicious, when injudiciously 
 administered ; and the worst of them may be useful, under cer- 
 tain conditions of the body. 
 
 733. Having made these preliminary remarks, we shall now 
 proceed to our proposed inquiry — Are there substances in com- 
 mon use as food, which generally disagree with, or are impro- 
 per for children before the first dentition is completed ? If there 
 be, what are they ? This question is, perhaps, fully answered 
 •already in various parts of this work ; but, as indulgence in cer- 
 tain articles at the period designated may be too often granted, 
 and thus tend to either the immediate, or remote injury to the 
 child, we shall consider them in detail ; and, first, 
 
 Sect. I. — Of Fruit in General. 
 
 734. Fruit may be considered, generally, of two kinds — 
 namely, fresh, and dried. 
 
 Of Fresh Fruit. 
 
 735. The fresh may consist of apples, pears, peaches, cher- 
 ries, raspberries, strawberries, melons, dewberries, blackber- 
 ries, whortleberries, grapes, oranges, pine-apples, &c. 
 
 736. Various opinions are entertained of the respective whole- 
 some qualities of the articles above enumerated, when ripe ; but 
 we believe there is only one, namely, that they are highly inju- 
 rious when they are not so. We shall, therefore, always be 
 considered, when speaking of fruit, to mean ripe or mature 
 fruit, unless it be expressly stated otherwise. 
 
 737. We limit ourselves, when speaking of the effects of these 
 
OF FRESH FRUIT. 22'3> 
 
 articles, to the period before the first dentition, or the first two 
 years of a child's life ; and it may be asked,— Is fruit of any kind 
 proper for children of that age ? 
 
 738. This question must mean one of two things — is fruit a 
 proper article of diet for children, at the period spoken of; or,, 
 will the occasional indulgence of a small quantity be improper? 
 As to the first, we would decidedly condemn any article enume- 
 rated, since it is almost uniformly mischievous. When fruit 
 is forbidden to children, it is asked, how can it be bad, since 
 they are so fond of it ; and since nature has furnished it so abun- 
 dantly ? As regards the first question, we would ask, are not 
 children as fond of wine, ardent spirits and many other impro- 
 per things, as of fruit? Yet you would not give them either of 
 these because they might take a fancy to it. They would eat the 
 fruit of the Jerusalem cherry, the berries of the laurel, or the 
 seed of the stramonium, with, perhaps, equal avidity, though 
 death would be the immediate consequence of the indulgence. 
 And, as regards the second, nature has spread her poisons with 
 as profuse a hand, as she has her more salutary fruits ; conse- 
 quently, the abundance of the substance cannot prove its use-* 
 fulness as food. 
 
 739. We, therefore, are of opinion, that whenever such a 
 quantity of fruit is given to a child, as shall, either by its quan- 
 tity or quality, materially change the nature of the digested pro- 
 duct, it is always bad ; consequently, such a proportion should 
 not be permitted to enter the stomach. Nor do we think it al- 
 ways safe, even in smaller quantities. If, on the other hand, so 
 small a quantity be given, as not to influence the digested pro* 
 duct, it may be given without injury, but, we believe, never 
 with advantage. 
 
 740. Fruit, by most people, is not only considered innocent, but 
 positively useful ; therefore, a free indulgence is generally per- 
 mitted in its use, without attending either to the age, peculiari- 
 ty, or condition of the person who may make use of it : yet we 
 hesitate not to say, that unless due regard be paid to each of 
 <these circumstances, fruit cannot be useful, and very often not 
 even innocent. It is familiar to the experience of every body, 
 that one class of substances is of more easy digestion than an- 
 other — thus, animal food is of more easy conversion than vege- 
 table. This, as a general rule, is strictly true*, and of animal 
 
224 OF FRESH FRUIT. 
 
 food, as we have already remarked, some is digested with much 
 more ease than others. The same remark is applicable to the 
 vegetable class— and of this class, fruit may be considered, with 
 young stomachs, of more difficult solution than almost any of the 
 farinaceous substances in common use ; consequently,, must be 
 less proper. 
 
 741. The insolubility of most fruits is well known to every 
 body, either from their own experience, or from their observa- 
 tions upon the confirmed adult stomach of others ; and, with re- 
 spect to children, the fact is notorious to all who may have charge 
 of them. Who does not constantly witness these substances 
 passing rapidly through them unchanged, and especially at the 
 age of which we are now speaking ? Can it, then, be for a 
 moment insisted on, that that substance which the stomach can- 
 not master, is useful, or even innocent? Let us not then be de- 
 ceived, by mistaking the agreeable for the useful. 
 
 742. At the age in question, the indulgence in fruit of any 
 kind should be very limited, indeed ; and especially where the 
 stomach and bowels are not in the most perfect health. After 
 this period, it may be given in moderate quantities, without much 
 risk ; but if there be even a small excess, the child is sure to suf- 
 fer from a derangement of the stomach or bowels, or both ; or, 
 if it escape from these evils, the stomach will be found less dis- 
 posed for its ordinary meals, and the articles will be seen to 
 pass unchanged. 
 
 743. There is -a vulgar error on this last point which deserves 
 correction ; as it has no inconsiderable influence upon the con- 
 duct of many, in administering fruit to children. The passing 
 of fruit unchanged through the bowels, has frequently been urged 
 to us as a proof of its innocent nature ; for, it is said, that "if the 
 child have taken a little too much, or if the stomach cannot assi- 
 milate it, it always comes away. Now, this coming away unal- 
 tered, is a direct proof that the stomach cannot digest it ; and, of 
 course, the child has been labouring under the effects of indiges- 
 tion; and though, in some instances, it has not produced any vio- 
 lent symptoms, it must, nevertheless, be admitted, that the child 
 runs a great risk. We should, therefore, lay it down as a posi- 
 tive rule, that whenever this is'observed with regard to any sub- 
 stance, no matter what, the stomach itself is out of order, or that 
 the particular substance is not suited to its powers, or condition, 
 
OF FRESH FRUITS 225 
 
 and must not again be urged upon it. It is owing to inattention 
 to these first revolts of the stomach, that dyspepsia is produced; 
 and farther heedlessness too certainly confirms it. 
 
 744. There is another vulgar error with respect to certain 
 fruits, which is even more mischievous than the one just men- 
 tioned ; namely, that they are not merely innocent, but positive- 
 ly wholesome. This opinion is especially entertained of the 
 dewberry, and the blackberry; hence, they have but too often 
 been administered to children, who were labouring under acute 
 or chronic diarrhoea, to the imminent danger of their lives. We 
 have witnessed, this season, (August, 1825,) three instances of 
 dangerous cholera, brought on by means of these fruits ; and 
 one which had nearly proved fatal, from the use of the sirup of 
 the blackberry. These instances are far from being rare ; we 
 have observed more or less of them, ever since we have been 
 engaged in practice. 
 
 745. We are fully aware how difficult it is to eradicate a long 
 established error; and that the dictum of an old woman will 
 very often outweigh the experience of the physician. We do 
 not, therefore, calculate too largely upon the force or influence 
 of our opinion upon this important point. We feel it, however, 
 a duty to state, that which has been sufficiently confirmed to us 
 with respect to these fruits, when exhibited as a remedy — 
 namely, that we have never known them to be useful ; but we 
 have very often known them to be injurious. 
 
 746. Another vulgar error, is deserving of notice — namely, 
 that " when cherries are eaten, the stones should be swallowed, 
 to promote digestion." This is one of the most absurd, as well 
 as dangerous errors, that popular opinion continues to cherish; it 
 is one replete with mischief, and has neither reason nor experi- 
 ence to countenance it. This mischievous practice, most proba- 
 bly, took its origin from the mechanical theory of digestion, or 
 from some ill-selected analogy. It was formerly taught, that tho 
 human stomach subdued the substances presented to it for diges- 
 tion, by a mechanical action ; and, that, consequently, the cher- 
 ry-stones performed the same duty in it, as the gravel in the giz- 
 zards of fowls. This opinion has been long disproved, by the 
 most satisfactory experiments ; but the errors to which it led, 
 still, unfortunately, continue to prevail; and this with a class of 
 
 29 
 
226 OF FRESH FRUIT. 
 
 people, from whom one would rationally expect better formed 
 notions. 
 
 747. The same disposition to theorize, has found a utility for 
 the purpose of digestion, in eating the skin of the apple and 
 peach. They say, that nature intended the skin to promote 
 this object : or why were they formed ? The same reasoning 
 would render it proper to swallow the shell of the walnut, and 
 the rind of the pine-apple : but did not the opinion lead to prac- 
 tical injury, it would not have been worth the trouble to expose 
 its absurdity. 
 
 748. From what has been said, the following principles, we 
 think, may be established : — 
 
 749. 1. That before the child has attained its second year, 
 fruit in any quantity cannot be considered useful ; though very 
 small quantities, properly administered, may do no injury. 
 
 750. 2. That after the second year, small quantities of fruit 
 may be given with less rfsk ; especially if we duly attend to the 
 circumstances which should always regulate its exhibition. 
 
 751. 3. That it should never constitute the chief article of 
 diet ; since, in such a proportion, it would so alter the digested 
 product, as might seriously injure the functions of the stomach. 
 
 752. 4. That frujj;, of almost every kind, is less digestible 
 than any of the farinaceous substances in common use. 
 
 753. 5. That when the stomach is incapable of assimilating 
 it, much disturbance in the stomach and bowels is excited, ter- 
 minating oftentimes in cholera ; or, 
 
 754. 6. If it do not produce this evil, it passes from the bow- 
 els in an unaltered state; and when this is the case, it is a cer- 
 tain evidence that it is injurious. 
 
 755. 7. That, as a general rule, the older the child, the less 
 the liability to injury from fruit, provided it be taken at proper 
 times, and in moderate quantity. 
 
 756. 8. That it is an error to suppose, that any fruit is posi- 
 tively useful, as a nourishment, or as a medicine, to young chil- 
 dren. 
 
 757. 9. That it is also an error, and one of a serious kind, to 
 swallow the stones or skin of fruit, with a v view to promote di- 
 gestion. 
 
OF DRIED FRUITS. 227 
 
 Sect. IT.— Of Dried Fruits. 
 
 758. The dried fruits are, raisins, cherries, apples, peaches, 
 figs, prunes, &c. Of these it may be said with safety, that they 
 are still more exceptionable than the fresh, but not all in an equal 
 degree. The most injurious are the four first named. Raisins 
 are extremely indigestible, unless deprived of their skin ; and 
 should never be eaten, without attending to this precaution — 
 there is no stomach, unless it be that of the ostrich, of whose 
 powers of digestion we hear so much, that can master the skin 
 of a raisin — we know from observation, that a hog cannot over- 
 come this insoluble substance; yet they are given by indulgent 
 parents, in large quantities, to children of every age, and of 
 every power of stomach, to either their immediate or remote 
 injury. We have known three instances of convulsions and 
 death, from the excessive use of this fruit. 
 
 759. Of the dried cherries, apples, and peaches, it may be said 
 that they are altogether unfit to be received into the stomachs of 
 children, and especially young children.* They, are rendered 
 fitter for the purposes of food, by having them well stewed ; but 
 even then, they should be taken in very moderate quantities — 
 particularly the cherries and dried apples. The fig, and the 
 prune, are less exceptionable than the articles just named : but 
 they cannot be freely indulged in, with entire safety, by young 
 children. The adult stomach, when sound, bears them with ad- 
 vantage when taken in moderation ; especially where the bow- 
 els are tardy — but they never should be given for the same pur- 
 pose to young children. 
 
 * We saw an instance of long-continued and severe convulsions in a child of 
 four years old, from eating a quantity of dried apples, which he had procured by 
 stealth; his recovery was doubtful for a long time, and nothing but being relieved 
 of the offending cause, by an active emetic, saved his life. 
 
228 OF EXERCISE. 
 
 CHAPTER XL 
 
 OF EXERCISE. 
 
 *■ 
 
 Of such importance do we consider a well directed and pro- 
 perly organized system of exercise, that we must hold every 
 system of education imperfect, that does not include it among 
 its essentials. For, without this, we can declare, from exten- 
 sive personal observation, much mischief is sure to follow : 
 while, on the other hand, we can safely say, where it has been 
 well systematized, it has uniformly tended to the successful de- 
 velopment of the body, as well as contributed largely to the in- 
 vigoration of the mind. With these objects in view, we were 
 mainly instrumental in establishing the gymnasium, that is now 
 dispensing so much benefit to youth and others, in our city; 
 and to the practices of which we cannot too pointedly recom- 
 mend the attention of parents and guardians, who may be soli- 
 citous about the welfare of youth under their care. 
 
 760. Under the head of exercise, we shall include, 1st, the 
 exercise or motion useful or proper for very young children, up 
 to the period of their beginning to walk ; 2dly, walking ; 3dly, 
 other modes of exercise — A, riding in a carriage ; B, riding on 
 horseback ; C, games of various kinds ; D, dumb-bells, and the 
 various exercises of the gymnasium. 
 
 Sect. I. — Carrying in the Arms. 
 
 761. Under this title, we may comprehend almost the whole 
 of the motion, or exercise, which can be usefully employed for 
 very young children ; and this may commence with advantage, 
 a few days after birth. An error is very frequently committed 
 by nurses and mothers, in confining the child constantly to the 
 bed, or cradle, covered with clothes, or buried in feathers, in- 
 stead of carrying it about the room several times a day, carefully 
 placed upon a pillow, that it may enjoy a renewed atmosphere, 
 and have an opportunity of exercising its little limbs, to which 
 
OF EXERCISE. 229 
 
 this important indulgence so strongly'invites them, even before 
 they are a fortnight old. The custom of confining a child at 
 this early period of its life, arose from the absurd aphorism, 
 that * the more a child sleeps, the faster it grows." 
 
 762. It should be ever kept in view, that children, with re- 
 spect to exercise, are precisely on a footing with adults, making 
 the proper allowances for degree. The muscular system of the 
 child, like that of the adult, can be strengthened only by exer- 
 cising it; and the circulatory, nervous, and absorbent systems, 
 can only be kept healtlry, by the due and proper play of the 
 muscular; therefore, for the purposes of health, it must acquire 
 tone, by a well regulated plan for this purpose, or all the sys- 
 tems just mentioned will become deranged, or even diseased. 
 
 763. If this be true, it will readily be admitted, that the sooner 
 we commence with this important part of physical treatment, by 
 a well adjusted plan, the sooner will the muscular system acquire 
 the tone, so important to the many other functions of the body. 
 
 764. To begin, then, with this useful practice sufficiently early, 
 the child should be taken several times every day, after its 
 wakings, from its nest of feathers, (even at ten days old,) and, 
 placed upon a plain, and sufficiently soft surface; freed from all 
 restraint, and left to the enjoyment of its own sensations. In 
 obedience to these, it will soon be found to exert its feeble limbs 
 in every direction ; and manifest, by its repeated efforts, the de- 
 lightfulness of its feelings. It will discover, after a few trials, 
 how much it enjoys this freedom from restraint, and the advan- 
 tage it is deriving from it, by an increased motion, and force of 
 its limbs. In the position we recommend, namely, upon its 
 back, it has a full opportunity of exercising all the larger mus- 
 cles of the body; and it is surprising, when permitted, how ra- 
 pidly the child acquires strength. 
 
 765. All seem to be aware of the necessity of exercise to 
 strengthen the musc lc :s; but there are very few. who institute a 
 regular and proper series of experiments, for this purpose. In- 
 deed, the exertions the poor infant is obliged to make in the 
 hands of its nurse, are calculated to do it more injury than good. 
 The pride of the nurse, and too often that of the parent, becomes 
 highly interested in the display the child is forced to make, in 
 keeping itself erect; and when from long and often repeated 
 trials, the little creature is able to straighten its spine, it is 
 
f 
 
 K 
 
 230 OF EXERCISE. 
 
 praised for its forwardness, or quoted as a prodigy. But this 
 kind of management is decidedly wrong; since all this apparent 
 vigour is oftentimes procured at the expense of some permanent 
 derangement of the spine. 
 
 766. It will be evident to every reflecting mind, that the in- 
 completely ossified spinal column is but ill calculated, at the 
 period now supposed, to sustain the weight of the whole body, 
 and the head beside, and, when forced to do so by this injudi- 
 cious management, it must yield, in a greater or less degree ; 
 hence, crooked spines. We would, therefore, peremptorily for- 
 bid all such displays. We are well acquainted with a nurse, 
 who from a perseverance, worthy of a more noble and useful 
 object, teaches the children sheiias charge of, to sit perfectly 
 upright, within the period of the month : it is truly ludicrous, as 
 well as unnatural, to see the little creatures sitting as straight 
 as if they were stiffened by a back board. What may, ulti- 
 mately, be the result of such a plan, remains to be proved — rea- 
 soning upon the subject, leads to nothing but gloomy anticipa- 
 tions. 
 
 767. From what has been said, it will appear, that, however 
 important exercising the muscles may be, it, nevertheless, must 
 be done, without obliging the spine to support the weight of the 
 body ; as it must do, when the child is placed in an er^ect posi- 
 tion. The employment of the muscles, must be the result of 
 the voluntary act of the child; and it will most certainly and 
 successfully exercise its volitions, when placed in a position 
 which frees it from restraint ; as on its back, with its head a 
 very little elevated. When thus situated, with all its limbs at 
 liberty, it will, in a very short time, become so familiar, and so 
 pleased with its exertions, that it will every day more and 
 more employ the muscles of these parts ; and, in a little time 
 more, it will use those upon the posterior part of the body, to 
 the manifest advantage of the yet feeble spine.* 
 
 * The universal and preposterous practice of bracing children, as it is called, 
 by straps, backboards, corsets, &c, has ever given rise to the disease they were 
 intended to prevent or to cure — namely, obliquities of the spine. This affection 
 first shows itself, by one shoulder becoming lower than the other, and by a pro- 
 jection of the portions of the shoulder blades next to the spine. These bones 
 are so elevated, sometimes, as to appear detached, or separated from their proper 
 location. We would, therefore, advise a mother, when she observes this change 
 in the child's shape, to apply immediately to an experienced physician, instead 
 of attempting to cure it, by the several contrivances just enumerated. 
 
OP EXERCISE. 231 
 
 768. Another error is usually committed ; namely, the mis- 
 management of the head of the child, daring all the various at- 
 tempts to make the child sit straight. During this discipline, the 
 head of the poor little infant is permitted to hang on one side 
 constantly, or it is suffered to roll about as if it were but loosely 
 attached to the body. The injuries arising from this inattention, 
 are — 1st, the child acquires a habit of holding its head upon one 
 side, which is difficult to overcome; it also does mischief to the 
 neck itself; for, 2dly, if permitted to roll about, injury may be 
 done to that part of the spinal marrow which passes through the 
 vertebrae of the neck, by the head making, from some cause or 
 other, too large a sweep ; or, in other words, describing too 
 large a portion of a circle. 
 
 769. To prevent these evils, we would recommend, — first, that 
 the child should never be placed in an erect position for any 
 length of time, before the spine is sufficiently confirmed to sup- 
 port the superincumbent weight, and the muscles have acquired 
 strength to support the body in that position, without too much 
 fatigue; and, secondly, if the child must be placed in an erect 
 position for any necessary purpose, the head should always be 
 steadily sustained by the hand of the nurse being placed under 
 it. The cautions now suggested are particularly important in 
 respect to feeble, or very heavy children, or those disposed to 
 rickets of scrofula. 
 
 770. The child's body may be placed so as to make an angle 
 of a few degrees with the horizon ; but when this is done, it 
 should always be by the hand of the nurse sustaining the back 
 and head, by placing it against the shoulders and head. The child 
 may be carried about in this position, and gently exercised, by 
 a movement up and dowm; this maybe repeated several times a 
 day, for a minute at a time. But we must earnestly deprecate 
 a too rapid motion, even in the direction prescribed ; but, espe- 
 cially, a whirling motion. If the movement prescribed (770) be 
 gently and properly managed, it not only tends to give strength 
 and vigour to the child, but becomes a certain source of amuse- 
 ment to it, as is c^irly demonstrated by its joyful expressions, 
 and strong attachment after awhile, to those who perform it. 
 
 771. We have said, this motion should be gently performed: 
 we would rather wish to be considered as insisting upon this as 
 an essential condition ; for if it be rudely done, mischief may 
 

 232 OF EXERCISE. 
 
 follow from the sudden shock the nervous system may receive. 
 The child, when this movement is carried to excess, expresses 
 its dislike, and apprehensions, by the sudden starts of its body ; 
 by its wild and affrighted looks ; and by its convulsive sighs, and 
 crying. We have strong reason to believe, in one instance, that 
 death followed, from this movement being too suddenly and vio- 
 lently performed. When properly conducted, it has all the ad- 
 vantages of swinging. The same censure must be passed upon 
 running violently with the child in the arms, hastily descending 
 the stairs, jumping, &c. 
 
 772. After the child has acquired sufficient strength to sit up 
 without much support, it may advantageously be indulged in it, 
 if properly managed ; that is, not too long at a time, nor too 
 often repeated. The spine of the child will rarely acquire such 
 firmness, as to render this proper, before the third month — after 
 this time, it will, all things being equal, gain strength daily; and 
 may now be occasionally carried on the arrn^of the nurse, pro- 
 vided she handle it properly — for on this much depends. We 
 shall, therefore, lay down the following rules; for carrying chil- 
 dren on the arm : — 
 
 773. 1. It should never be so placed upon the arm, as either 
 to oblige it to support itself, or fall backward. To prevent this, 
 the hand of the arm on which the child does not rest, should be 
 so placed over its body and chest, as to give a certain support 
 to the whole body. 
 
 774. 2. It should never be carried upon the arm, without ad- 
 ditional support, until the muscles of the neck have acquired 
 sufficient strength to carry the head straight, for reasons alrea- 
 dy suggested. 
 
 775. 3. It should not always be confined^ to one arm ; for if 
 it be, it will, from maintaining one position too long, contract 
 a habit of leaning to one side, or become crooked — therefore, 
 the arms should often be changed. 
 
 776. 4. It should not be made to put an arm around the 
 nurse's neck, while placed on the arm for carrying ; as it will 
 do' injury to the side and back, by forcing»ut the shoulder- 
 blade. 
 
 777. 5. Neither should it be too firmly grasped by the nurse's 
 arm, lest it bend or distort the bones of the pelvis, thighs, and 
 legs; and on this account, the child should not be often trusted to 
 
OF EXERCISE. 233 
 
 those who are unskilled in carrying one; as they always embrace 
 the child very firmly, from an apprehension they may let it fall 
 — an experienced nurse can carry a child without much pres- 
 sure. This rule is of especial consequence to such children as 
 may be disposed to rickets. 
 
 Sect. II.— Of Walking. 
 
 773. Before a child can learn this important art, if we may 
 so term it, it has to acquire several powers — 1st, that of using 
 its limbs in all directions ; 2dly, crawling, 3dly, standing, or ba- 
 lancing: 4thly, the moving without falling, of one leg before the 
 other ; which in its perfection is walking. 
 
 779. We have already directed the best method of ensuring 
 the first, which, if properly pursued, will quickly lead to the se- 
 cond, in which the child should be most freely indulged., without 
 regard to the soiling of clothes, or the destruction of such perish- 
 able articles as it may be able to lay its hands upon. Most pa- 
 rents have an aversion to this necessary acquirement, and too 
 frequently endeavour to interrupt it, to the decided injury of 
 their offspring. We have constantly observed, that those chil- 
 dren who learn to crawl, are" always more robust, and better 
 confirmed in their w T alk, (though they sometimes do not begin 
 so early,) than those who have been taught to walk without this 
 useful intermediate step. The act of crawling exercises every 
 muscle of the body : and this, without much fatigue — since it is 
 a voluntary act of the child ; besides, it is highly pleased by the 
 employment of this power, for it always has an object for its 
 exertions — consequently, is sure to be amused. This exercise, 
 therefore, not only gives vigour to the body, but also agreeably 
 stimulates the mind. 
 
 780. Children permitted to crawl, will soon wish to do more ; 
 hence, they will endeavour to lift themselves upon their feet bv 
 the aid of a chair ; and though they may fail in many attempts, 
 they seem to feel it to be a point proper to gain, and will perse- 
 vere until they accomplish it; by this they learn— 1st, to raise 
 themselves from the floor : and, 2dly, to stand, by holding the 
 object on which they have seized. Presently, they can balance 
 themselves without holding; and will proudly show you, they 
 can stand alone. But fearful of yet (rusting themselves to move • 
 
 30 
 
234 OF EXERCISE. 
 
 their limbs, without support, they do not venture to put one foot 
 before the other; but by seizing a chair, or some other support f 
 they will venture to advance as far as the limits of their sup- 
 port wi$ permit. This little adventure is repeated again and 
 again, with increased exultation ; when, after numerous trials, 
 they feel confident of their powers to balance themselves, and, 
 to. the inexpressible joy of the parents, they run alone. When 
 children learn to walk by this important gradation, it is always 
 found that no injury is done to the proper form of the legs, 
 which but too frequently happens by the other plan. 
 
 781. It may, therefore, be useful to caution parents and nurses 
 against the unnatural practice of forcing very young children to 
 "find their feet;" since curved legs are almost sure to result 
 from the practice.* Children disposed to rickets should be par- 
 ticularly preserved from this mischievous exercise. For it, doubt- 
 less, was the intention of the Creator, that children should not 
 walk before a given period ; therefore, to prevent an abuse of 
 this law, he annexed a penalty to its infringement. 
 
 782. We grant that children may be taught to walk, without 
 previously crawling ; but, at the same time, we must insist that 
 there is no advantage in this plan — nay, there is often positive 
 injury, the limbs are almost sure to be curved, and the walk of 
 the child is marked by an uncertainty which does not obtain by 
 the other plan. By crawling, the bones of the legs and arms 
 strengthen with the muscles ; and this, without curvatures of the 
 legs, since they are not forced to support a weight beyond the 
 power of resistance. 
 
 783. Many plans have been devised to teach children to 
 walk — we without ceremony condemn the whole,, since they all 
 consist in obliging the child to make exertions injurious to the 
 form of their limbs — of this kind are the go-carts, the leading- 
 strings, &c. The go-cart and leading-strings are banished from 
 the nursery, in almost every part of this country ; and we sin- 
 cerely hope that no false theory, or an attempt at a " royal road " 
 
 • Does not nafcttre point out the fact, that very early walking is not one of her 
 intentions? by developing' the lower extremities while in utero, more slowly than 
 the upper? which disparity continues for even months after birth. It would 
 seem to say, there is no necessity for a more ample development of the legs, as 
 their use will not be required for some time. Whereas the use of the arms is 
 immediately required after feirth, for the purposes of aiding itself in the acquire- 
 ment of its Jbod. 
 
Of EXERCISE, 235 
 
 \o walking, may ever cause them again to be introduced. Those 
 countries in which these artificial means have been most fairly 
 tried, abound most in ill-formed legs— an indisputable evidence 
 of their mischievous tendency. 
 
 784. Teaching children to walk by taking hold of one of their 
 hands, is also a very exceptionable mode. In this case the arm 
 is severely extended ; and, should the child make a false step, it 
 runs the risk of a dislocation, by the violent and sudden attempt 
 to save it—or, should it escape a dislocation, the arm suffers a 
 violent extension of its muscles and ligaments, from which it is 
 sometimes a long time before it recovers, as well as subjecting 
 the poor child to a great deal of pain. Both hands being held 
 at the same time, is less exceptionable, but not entirely free from 
 objections. The best way is to let the child depend pretty much 
 upon itself — taking care to break a fall, by gently seizing it 
 round the waist. 
 
 Sect. III. — Of other Modes of Exercise. 
 
 785. After a child has learned to walk with tolerable steadi- 
 ness, it is eager to employ its locomotive powers, by moving al- 
 most constantly from place to place, either to relieve ennui, or 
 gratify curiosity, or both ; hence the desire of motion being so 
 universal, that it may be considered an instinct. This kind of 
 gratification they should be liberally indulged in, since it keeps 
 the mind amused, and profitably employs the muscular system — 
 consequently , there can be no exercise so unexceptionable as that 
 of walking under proper circumstances. But it may happen, 
 that from the state of the w T eather, indisposition, or the distance 
 to which it is desirable to remove them, other modes of trans- 
 portation must be resorted to ; and the choice of such as present 
 themselves, must depend upon the age of the child, distance, &c. 
 We shall, therefore, consider — 
 
 A — Riding in a Carriage, 
 
 786. Our remarks upon carrying children on the arm, lead to 
 the conclusion, that it is not always the best mode of exercising 
 them ; therefore, we are of opinion, that much advantage is of- 
 tentimes gained by the well regulated use of the " baby car- 
 riage." This, however, to be as useful as it is capable of being, 
 must be governed by the following considerations : — 1st, the ve- 
 hicle itself; 2dlv, the mode of using it; and 3dly, the child. 
 
236 OF EXERCISE. 
 
 . 787. J. The Carriage. — If should be so constructed, as to 
 render it difficult to be overset; therefore, the wheels must be 
 made low, and revolve easily, and equally ; the axle should be 
 wide, that the carriage may have even an over proportion of 
 base. The body should be sufficiently long to permit the child 
 to lie at full length, when necessary ; and of such breadth, as 
 shall prevent its being cramped, when placed in it. It should 
 be of such depth, as will prevent the child from falling out ; and 
 its height should be so arranged, that the child may be protected 
 from the sun, when this may be necessary. The wheels should 
 be secured against running 6u, when the carriage is in motion. 
 The body should be placed upon low springs, of sufficient elas- 
 ticity and strength. 
 
 788-. 2. The .Mode of using the Carriage — is highly important, 
 since an error in this point may defeat its best uses. To be 
 useful, therefore, it should always be drawn steadily, and at a 
 very moderate pace; it should never be violently jerked, nor 
 rapidly put in motion. The place for its employment should al- 
 ways be smooth j and free from obstructions; as its passing 
 over rough places endangers the child, since it may overset, or 
 do injuiy by the severity of its motions. 
 
 780. 3. As regards the Child. — That this kind of exercise may 
 prove beneficial, the child must be so disposed in the vehicle, as 
 to be perfectly at ease. The most suitable position Yor this 
 purpose, will depend very much upon the age of the child ; we 
 may, therefore, divide this into three periods— the first period is 
 that, before the child can securely sit alone; the second, is where 
 it is able to sit alone, but cannot walk ; the third, is after the 
 child can run alone. 
 
 790. The position for the child in the carriage, at the first 
 period, should be a horizontal one,and,for the reasons suggested, 
 with its head elevated. It should be secured against receiving 
 injury from a sudden jolt, by laying it upon a pillow, or an 
 elastic mattress ; and so confined at its sides, as to prevent its 
 romng when in motion. The one for the second period, may 
 be that of sitting; but the child must be so secured, as to pre- 
 vent too much motion of its body, when the carriage is moving. 
 For the third period, the same position will be proper; but there 
 will be less necessity for the confinement just spoken of, as the 
 child can now balance and support itself. Yet it may be pro- 
 per to observe, that the greatest care should be taken at every 
 period, to guard against the child's falling out. 
 
OF EXERCISE. 237 
 
 791. Children, when placed in the carriage, should never be 
 kept standing in the sun, if it be warm; nor should they be kept 
 motionless, when the weather is very cold. Indeed, it would 
 always be best, not to expose to either extreme; since the 
 risk of injury is oftentimes greater than the benefit. When in 
 the carriage, in cold weather, they should be amply covered, 
 since, from the passiveness of their situation, they will require 
 additional clothing. Nor should the ride ever exceed half an 
 hour at a time, especially if the child be observed to become 
 sleepy — and this for two reasons : first, because it is always inju- 
 rious to children to sleep in the open air ; and, secondly, because, 
 after a few trials, they Avill much prefer this mode of going to 
 sleep ; • and thus destroy a w r ell established habit, to the serious 
 inconvenience of the parent or nurse. 
 
 B — Riding on Horseback. 
 
 792. Perhaps there is no mode of exercise, equally beneficial 
 with this, if we except walking — it is one which employs all the 
 energies of the rider, and that in the most agreeable way. There 
 h scarcely a muscle unemployed, and* at the same time, the mind 
 is highly amused. We must, however, be understood to speak 
 of those who feel a confidence in their horsemanship ; for such 
 only derive benefit from it. Therefore, a child, either male or 
 female, should be early instructed in this important art. We say, 
 they should begin at an early period to take lessons, when prac- 
 ticable ; since, by doing so, they become more confident, and bet- 
 ter confirmed in their seat. When placed on horseback at an 
 early age, they quickly acquire intrepidity ; first, because they 
 have a natural attachment to a horse, which they suppose will 
 not do them harm ; and, secondly, because they cannot well an- 
 ticipate all the risk they might run, either from the mismanage- 
 ment of the reins, or the viciousness of the animal itself. On 
 this account, children ^ire fearless on horseback, almost as soon 
 as they are placed there ; and their enjoyment keeps pace with 
 their trials ; and for these reasons, the sooner they begin, the bet- 
 ter for every purpose of health, or future usefulness. 
 
 793. We would advise, under circumstances which can com- 
 mand this indulgence, that children commence, soon after their 
 sixth year, to receive instructions under a careful and experi- 
 enced master; and, as soon as they have acquired " a good seat," 
 thev may accompany their father, a friend, or a careful servant. 
 
238 OF EXERCISE, 
 
 for farther improvement and exercise; A timid child should not 
 be forced suddenly to mount a horse, for any purpose ; he ought 
 to be placed under the immediate care of a judicious person, 
 who, by address and management, will remove his apprehen- 
 sions, and cause him eventually to acquire a confidence in him- 
 self. On this account, a riding school is deserving of patronage. 
 
 G — Of Games, and Exercises of various kinds. 
 
 794. In large cities, there is a great variety of games and ex- 
 ercises presented for the amusement of children; some of which 
 are very useful, and others extremely injurious.- It would oc- 
 cupy too much room to particularize the varieties, and reason 
 upon them in detail. We shall, therefore, merely point out the 
 tendencies of them all, and allow parents to choose such as will 
 best conform to the general scheme of physical education. 
 
 795. All the active games and exercises, (and these are the 
 kinds we are now considering, since they afford that important 
 aid to health, exercise,) employ all the muscles of the body with 
 more or less severity ; the remote tendencies of which, are to 
 confirm the strength, and improve the skill of such as sufficient- 
 ly employ them. But these advantages are not always gained 
 without risk ; either from the nature of the game or exercise it- 
 self, or from the severity with which it may be pursued ; there- 
 fore, such as really may be attended with danger, had better be 
 avoided at once ; and only such followed as are not necessarily 
 accompanied by risk. Of the former kind may be considered 
 skaiting; going into the water unprotected, before they can swim ; 
 descending from the tops of houses by a running rope, or wind- 
 lass ; diving or jumping into the water from a great height, &c. 
 Of the latter, we may reckon playing at marbles, beating a hoop, 
 flying of kites, playing at ball, or fives, shinny, &c. These last 
 are not necessarily dangerous, but may he so accidentally — we 
 would, therefore, lay down the following general rules upon 
 games and exercises : — 
 
 796. 1. Not to permit a child to engage in such as are in 
 themselves dangerous, as those above enumerated; and not to al- 
 low the plea, that A, B, and C, daily engage in them without 
 accident, to outweigh the force of positive examples to the con- 
 trary. 
 
 797. 2. To allow a child to engage only in such as are not 
 
OF EXERCISE. 239 
 
 necessarily injurious ; and even such within the bounds of mo- 
 deration, in order that evil may not follow the indulgence — 
 that is, not to overheat the body, nor check perspiration too 
 suddenly. 
 
 798. 3. To choose such of the latter, as may prove least in- 
 jurious to the child's morals; for, by associating with vulgar 
 characters, in the performance of certain games and exercises, 
 much risk is incurred, On this account, a child is seldom safe, 
 either morally or physically, who is permitted to choose its com- 
 panions, the nature of its game, or amusement, from under the 
 parent's inspection and control. 
 
 799. Girls, from necessity, can have fewer games or amuse- 
 ments than boys ; but there is a sufficient choice of these, for 
 all the purposes of health, if properly pursued — such are, shut- 
 tlecock, and battledore; skipping the rope, dancing, &c. Where 
 circumstances will permit, a well arranged swing is one of the 
 best, as well as one of the most delightful modes of exercise, to 
 those who can enjoy it. Riding on horseback, we are sorry to 
 observe, is too little practised among our young females. Un- 
 fortunately, this, like many other points essential to health, re- 
 quires the powerful influence of " fashion," to bring it into use. 
 There is, perhaps, no city in the world, where females enjoy 
 this most salutary exercise so little as in this ; and, perhaps, 
 there is none that offers stronger inducements to employ it. 
 There are always masters to teach the art, where encourage- 
 ment is given: but of the jiumber who have offered their ser- 
 vices to the public, not one, we believe, has succeeded. On 
 what does this supineness rest? 
 
 D—Dumb-Bells. 
 
 800. The '* dumb-bells " have been strongly recommended as 
 an exercise for young people, especially when the weather will 
 not permit it to be taken out of doors. These machines may be 
 profitably employed, we have no doubt, where the weight of 
 them, and the manner of using them, are properly regulated. 
 The general idea is, that they should be made as heavy as the 
 strength of the person can* wield, than which, there can be no 
 greater error — for all the advantage of weight can be gained, by 
 using light ones, if the motions of the arms be quickened ; and 
 this need not be done, but as the person acquires strength. But 
 
240 OT BATHING, AND CLEANLINESS. 
 
 such as have the opportunity of attending the exercises of the 
 " Gymnasium/' will have the use of these instruments, as well 
 as many other modes of exercise, properly pointed out, and 
 their employment judiciously regulated. 
 
 CHAPTER XII. 
 OF BATHING, AND CLEANLINESS. 
 
 SOI. It is a popular belief, and one founded upon correct ob- 
 servation, that the proper and healthy condition of the perspira- 
 tory organ, — namely, the skin, — is highly important to health. 
 Whenever this apparatus becomes deranged, either directly or 
 indirectly, it is always found, that the body is less in the enjoy- 
 ment of health and comfort, than when this is in the full exer- 
 cise of its functions. It will, therefore, follow, that whatever 
 tends to maintain the sensible and insensible perspiration in 
 their proper proportions, will essentially serve the purposes of 
 health. It has ever been acknowledged, that cleanliness is highly 
 conducive to this desirable end ; for, wherever this is neglected, 
 disease is sure to follow — therefore, the impure state of the skin 
 will sooner or later have its penalties. 
 
 802. The ancients were well acquainted with this fact ; and 
 so attentive were they to the removal of 'all casual impurities 
 from the skim; so entirely convinced of the advantages result- 
 ing from it, that baths were erected and maintained, in many of 
 their cities, at public expense; of which the inhabitants of the 
 respective cities had a right to take advantage, at any time 
 they pleased. These valuable gifts of public munificence, can- 
 not well be too much praised, or admired, and could they have 
 been perpetuated to the present moment, in all such climates 
 where heat makes them desirable, incalculable advantages 
 would have arisen, to reward the liberal spirit by which they 
 were maintained. 
 
 803. Although there are no baths maintained at the public ex- 
 pense, in this country, we are, nevertheless, in possession of suf- 
 ficient facilities for bathing, in almost every part of the United 
 States, either by means of running water, or the late general in- 
 
OF BATHING, AND CLEANLINESS. 241 
 
 troduction of baths, in almost every well built modern house in 
 our cities. Therefore, when this important auxiliary to health 
 is not attended to, it must be attributed to reprehensible ne- 
 glect, 
 
 804. Parents who are inattentive to the important duty of 
 having their children well cleansed, by the frequent application 
 of water to their skins, disregard one of the most valuable pre- 
 cepts which Hygeia can give, or that they can obey ; and for 
 the neglect of which, no adequate excuse can be urged, espe- 
 cially as the means are at the command of every hody. In a 
 climate like the one we are subject to, where the extremes of 
 heat and cold are alternately experienced in their respective 
 seasons, too much care cannot be taken to preserve the skin in 
 its most healthy condition ; especially during the summer months, 
 that disease may not result. Therefore, the useful discipline 
 of washing, (every young member, at least, of the family,) 
 should never be omitted, If this were done daily, during the 
 warmer parts of our seasons, it would be but complying with a 
 necessity, constantly created, by the action of heat upon the 
 skin ; it should not be omitted beyond every other day, unless 
 some circumstance of health might render it improper. 
 
 805. The object of all bathing, is to remove impurities arising 
 from dust, perspiration, &c, from the surface, that the skin may 
 not be obstructed in the performance of its proper offices. But 
 it requires to be cautiously conducted, that the subject may not 
 be exposed to the risk of taking cold— it should > also, be so ma- 
 naged, that too much reaction shall not be excited. To ensure 
 these important ends, the bath should be of tepid warmth, at 
 least for several of the first years of the child's life ; for by having 
 the water very moderately warm* we remove with more facility 
 and certainty the impurities from the skin; we prevent taking 
 cold, and do not excite too much reaction.. Of the best mode of 
 conducting the bathing t we shall speak by and by. (827, &c.) 
 
 806. We are aware, we are advancing opinions not in con- 
 formity with public prejudice; but we declare them without he- 
 sitation, as we are certain they are sanctioned by both reason 
 and experience. The cold, is the favourite bath of people in 
 general ; but why it should be so, we are utterly at a loss to un- 
 derstand. This popular feeling originated in some unaccount- 
 able prejudice, or froni an imposing, but limited experience. 
 
 31 
 
242 OF BATHING, AND CLEANLINESS. 
 
 But as it has taken possession of the public mind, it may" be 
 well to urge with all due candour, our objections to its employ- 
 ment. 
 
 807. 1. There are many latent predispositions to disease, or 
 disease in an obscure form, to which the cold bath would be 
 highly injurious, by calling into action the dormant affection, or 
 by exalting the one already present. 2. There are many con- 
 stitutions, wherein the powers of reaction are so feeble, that the 
 body is left in a state of exhaustion for a long time, because re- 
 action is tardy in taking place ; and wherever this happens, the 
 system is sure to be weakened, instead of being invigorated. 
 3. There are many, who have strong dispositions to local deter- 
 minations of blood; as to the head, lungs, liver, &c; in which 
 cases, the cold bath is decidedly mischievous, by encouraging, 
 or producing these determinations. 4. It has, sometimes, the 
 most injurious effect upon the nervous system, producing a kind 
 of syncope, or catalepsy. We know a lady who was nearly de- 
 stroyed in this way, by a single plunge in the cold bath, although 
 of moderate temperature — the warm, or tepid bath, she much 
 enjoys. 5. The reaction, after cold bathing, is sometimes ex- 
 cessive, amounting, in some instances, to temporary fever ; and 
 when this subsides, the muscular system is found weakened. 
 6. It never answers the purposes of cleanliness so well as the 
 tepid, or warm bath — therefore, one of the principal advantages 
 for which it was resorted to, is defeated. 7. It is always com- 
 menced with strong repugnance on the part of the subject of it, 
 whether it be a very young child, or a child of more advanced 
 age — the first, manifests its aversion, by crying during the con- 
 tinuance of the discipline ; the second, by strong opposition, cry- 
 ing, &c. 8. In very young children, it sometimes produces se- 
 vere pain in the bowels, which can only be allayed by laudanum, 
 as the following case, among others, will show: — 
 
 808. We were requested to prescribe for a child of six weeks 
 old, who, from the moment it was stripped for dressing, began 
 to cry, and would not cease, until it took laudanum, for the pur- 
 pose of quieting it ; and this was uniformly the case, from the 
 first dressing after its birth. We inquired into the mode of 
 washing and dressing it, and were informed, that the nurse had 
 begun by washing it with cold mater, and the practice had been 
 continued ever since ; and that as soon as the water was applied 
 
OF BATHING, AND CLEANLINESS. 243 
 
 to it, it would begin to scream ; that after it had been well 
 washed from head to foot with the water, it was again washed 
 with cold whisky, and then dried and dressed ; that it remained 
 cold and shivering for a long time after the washing ; and that 
 it continued unceasingly to cry, until quieted by laudanum, or 
 carminative. We recommended that it should be washed with 
 warm water instead of cold, and to lay aside the use of the 
 whisky. On the repetition of our visit, a few days after, we 
 were informed, that the child had been nearly quiet during the 
 dressings, and only cried while, that w^s carrying on, and ceased 
 altogether to do so, as soon as this duty was performed ; and 
 that it had not required laudanum, since the warm water had 
 been substituted for the cold. 
 
 809. In the case just related, it is evident, that the use of the 
 cold water was injurious ; it produced a painful condition of the 
 bowels, which could only be relieved by anodyne medicines. 
 The child, therefore, was not only made to suffer much pain by 
 its use, but was acquiring a habit of taking laudanum, which 
 could not fail to be ultimately injurious. 
 
 810. It must, however, be understood, that we are not con- 
 demning the cold bath, without reserve ; on the contrary, we 
 regard it as a highly important remedy, where the condition of 
 the system indicates it; but we are decidedly of opinion, that 
 the constant use of it should be reserved almost exclusively for 
 this purpose. The occasional use of the cold bath, to people in 
 health, may safely be indulged in ; but it should be sparingly 
 had recourse to, unless employed as a remedy. We shall not 
 here treat of the cold bath as a remedy — our present object is 
 limited to the question, whether it, or the tepid bath, as a con- 
 stant, daily application, be most conducive to the objects of * 
 health, and cleanliness. 
 
 811. We are, however, by no means sanguine, that we shall 
 make many converts to the opinions we are advocating, as the 
 prejudice in favour of the cold bath is inveterately fixed in the 
 minds of most people. It is almost universally said to be 
 "bracing," and the warm or tepid bath to be relaxing; than 
 which, nothing can be more unfounded : the cold bath, in many 
 instances, such as those already enumerated, as well as some 
 other, ceases to be bracing; while the warm, in those very in- 
 stances, would decidedly have this effect. 
 
244 OF BATHING, AND CLEANLINESS. 
 
 812. But there is scarcely any thing more vague than the re- 
 lative terms of hot and cold, applied to the sensation created 
 on the living body, by media of various temperatures. It will 
 be proper, therefore, to signify by some definite sign, what is to 
 be understood by the cold and warm baths. 
 
 813. By the cold bath we are to understand, water so reduced 
 in temperature, that when applied to the human body, it shall 
 produce that sensation of coldness* called a shock. Now, there 
 are various conditions of the body, which will necessarily pre- 
 vent any fixed degree from producing this effect, unless we run 
 into an extreme ; we can, therefore, only assume some general 
 positions : but we must always be understood to mean, the ef- 
 fect of such application upon the body when in health. It will 
 be readily seen, that we can fix with certainty the lower ex- 
 treme of temperature ; since water will not bear a greater re- 
 duction than 32° of Fahrenheit without freezing. The other is 
 not so easily fixed, since it may vary from 62° to 82°, as we 
 are informed that the Buxton water is at that temperature, and 
 a slight shock is experienced upon immefsion; the medium 
 would, therefore, be 72°. Watdf , at this temperature, will feel 
 cold to the body; and at 62°, it will be found pretty severe, es- 
 pecially in summer, if applied in the form of the shower-bath, 
 though it is called temperate heat. 
 
 814. The warm, or tepid bath, may consist, then, of a tem- 
 perature, under'some circumstances, above 82^ or from this to 
 98°, the usual heat of the human body— beyond this, it becomes 
 a "'hot bath/' and should, like the cold bath, be ernployed but 
 as a prescription of the physician ; but we are not how consi- 
 dering this important auxiliary, except as a means to ensure 
 cleanliness. -Of this important part of physical education, too 
 much cannot be said in commendation — it may truly be said to 
 be a virtue. 
 
 815. No mother should confide this duty to a servant — she 
 should herself daily inspect the skin of her children, and see that 
 no part of it has been neglected. It is not sufficient for the pur- 
 poses of health, or cleanliness, that the hands and face are 
 washed — there are many other parts of the child's body, which 
 require a more rigid attention, and which, because out of sight, 
 are too often neglected. Nothing, perhaps, in after life, so ef- 
 fectually administers to comfort, as the practice of habitual clean- 
 
OF BATHING, AND CLEANLINESS. 245 
 
 liness ; it is also one of the most efficient means of preserving 
 health. But this habit, (or we had like to have said, this vir- 
 tuous feeling,) is rarely generated, if it have been neglected in 
 early life. 
 
 816. An attention to cleanliness costs neither time nor mo- 
 ney beyond its worth ; for the cleanly man or woman, can make 
 their toilet with as much despatch as the sloven, or the slat- 
 tern ; and they gain by it, that which the others can never ex- 
 perience — a feeling of inexpressible comfort. 
 
 817. As a preventive of disease, it stands foremost; for the 
 origin of some of the most loathsome diseases, may be traced to 
 ti neglect of this virtue; it should, therefore, be practised, and 
 inculcated, from the earliest infancy, to that period of life, at 
 which the child is able to judge for itself; when, if it have been 
 brought up with proper habits, it will spontaneously decide in 
 favour of bathing. Let any one inspect the nurseries of chil- 
 dren who are slovenly, and of those carefully brought up, and 
 the very first glance will convince him of the advantage of the 
 latter, and the mischievous tendency of the other. 
 
 818. Children may be so trained to cleanliness, that, at a very 
 early period of their lives, they will avoid soiling themselves. 
 A friend informed us, that the little patient of eight months old, 
 for which we were prescribing, had not worn a diaper since it 
 was a month old ; nor had it in a single instance soiled itself, 
 either during the day or the night. When it felt a necessity, it 
 would by signs make it known in such good time as to prevent 
 accident. This, we admit, to be a rare instance of discipline, 
 but it is not the less worthy of imitation. 
 
 819. If this practice cannot always be attained, one of near- 
 ly as much consequence certainly can— -namely, teaching the 
 child, by frequently changing it, to feel uncomfortable when 
 wet or soiled; and it will by its cries almost immediately make 
 its condition known, and plead for relief. The above case, 
 shows us how successfully this has been done ; and we believe 
 we may safely add, how easily it may be done, if properly com- 
 menced, and duly persevered in. For such is the effect of cus- 
 tom and good management, that children will very early de- 
 clare their wants as regards their evacuations, if they be fre- 
 quently placed upon the chairs, whenever they seem to manifest 
 a desire to relieve themselves. 
 
246 OF BATHING, AND CLEANLINESS. 
 
 820. The example of other children, when there are such, will 
 much contribute to establish this habit ; if the older be placed 
 upon the chair, the younger will soon be willing to follow their 
 example — and thus regularity will certainly be produced. This 
 practice may be subjected to certain periods, by placing the child 
 upon the chair at certain hours ; for instance, soon after they rise 
 in the morning, towards noon, and in the evening. But in doing 
 this, the child must not be neglected at the intermediate periods, 
 if it discover any marks indicative of its wants. 
 
 821. Nothing, perhaps, will so decidedly prevent that dis- 
 gusting and indomitable habit of " wetting the bed;" since no- 
 thing so certainly tends to produce it, as permitting children to 
 remain long wet ; as evacuation will follow evacuation, until 
 the habit is confirmed, by all sense of inconvenience being lost. 
 
 822. It may be proper to say, en passant, that we do not con- 
 fine the observance of cleanliness to the healthy condition of 
 the body alone ; for if the child be ill, frequent changes become 
 even more necessary, though the popular opinion be against it. 
 
 823. We have already declared ourselves to be in favour of 
 tepid water for washing children, from birth until they are at least 
 two years old. If at this period a change be thought desirable, 
 the water may be used a little colder; but it must be recollected 
 that if a change be made, it should be done gradually, as we 
 have just stated ; so that the constitution may not be subjected 
 to too sudden a trial, by a great difference in temperature. Ex- 
 tremes of every kind, we again repeat, are dangerous ; there- 
 fore, the gradation should be from tepid to cool, and from cool 
 to cold, if this last should ever become necessary, even as a 
 remedy. 
 
 824. We would, however, caution the over-timid mother, not 
 to mistake hot, for warm, and thus defeat every advantage which 
 the rules we are inculcating are intended to confer. This error 
 would be as bad as the other-, for injury would certainly follow. 
 So much does theory sway the actions of every one, that man- 
 kind frequently pursue opposite plans, to accomplish the same 
 and. A delicate, frail constitution will be treated by contrary 
 means, agreeably to the particular notions entertained by the per- 
 son who has charge of the patient, respecting the cause of disease, 
 ortheeffects of remedies. Thus,for the removal of debility, which 
 
OF BATHING AND CLEANLINESS. 247 
 
 they suppose to be the sole cause of disease, the cold bath is pre- 
 scribed by some, with a view, as they say, to brace the system ; 
 while others will employ the hot, that^the feeble strength of the 
 patient may be fostered. 
 
 825. In this case, either of the plans might be wrong, since 
 each is an extreme ; consequently, neither can be ultimately 
 proper, except in a very few instances, and in no instance should 
 we commence with either extreme. In all cases, the tempera- 
 ture of the water, should be regulated by the degree of vital 
 energy ; for, though children of enfeebled constitutions are in- 
 vigorated by a moderate bath where there is no contraindication 
 to its use, yet they would be as certainly injured by the sudden 
 application of the cold bath. So, on the other hand, a similar 
 state of body may be cherished and improved by the tepid, yet 
 might be severely injured by the hot bath. 
 
 826. But, as neither the hot nor the cold bath should be used 
 without the advice of a physician, they should always be con- 
 sidered as remedies of great power, and only to be used as such, 
 and for the diseases for which they are proper. The indiscrimi- 
 nate use of both, has done more injury, we fear, than can be 
 compensated for by the good derived from their proper appli- 
 cation. 
 
 827. Dr. Struve lays down the following rules for bathing 
 young children: — " During the first three months of its life, an 
 infant ought to be bathed in moderately warm water;* the 
 
 * "The term moderately warm, implies that degree of heat, when the hand, 
 or if this be not sufficiently sensible, the foot, may remain in it for some time; 
 without experiencing- the least disagreeable sensation. The lukewarm bath, is 
 about the temperature of warm milk. The cool bath signifies a temperature 
 equal to that of water which has been kept in a room for a considerable time, so 
 that its chilnessis taken off. And the cold bath ought to correspond with river 
 water, in the height of summer," (p. 353.) 
 
 It will readily be perceived, that Dr. Struve's definitions of temperatures are 
 extremely vague, since he does not measure them by the thermometer. Willicli, 
 his translator, has succeeded in being explicit, by saying, "Immediately after the 
 birth of a child, the water in which it is bathed, ought never to exceed the 98th 
 degree of Fahrenheit's thermometer. By progressively reducing the warmth one 
 degree every month, it will stand at 86° when the child is a year old, which, I 
 presume, will produce the sensation of what Dr. Struve calls lukewarm: — if this 
 temperature be still farther reduced in the next twelve months, so that the mer- 
 cury in the glass falls to 74°, when the child has completed the second year of 
 its life, it may then with propriety be termed a cool bath ," (p. 354.) 
 
248 OP BATHING AND CLEANLINESS. 
 
 next nine months, the water should be only lukewarm; after the 
 first year, its temperature may be still more reduced; and after 
 the second, the bath should be cool. From the third year of its 
 age, we may venture to bathe a child in cold water ; but it 
 should always be remembered, I do not mean as cold as ice."* 
 
 828. There can be nothing more preposterous, or injurious, 
 than the empirical use of the hot, or cold bath, since they are 
 •confessedly powerful agents ; but warm, tepid, or cool water, 
 for the purposes of cleanliness, may be daily used, under pro- 
 per restrictions, not only with safety, but advantage. 
 
 829. We say, under proper restrictions ; by this, we mean — 
 1st, that the child, when about to be washed, should be exposed 
 no longer than is absolutely necessary for the operation ; 2dly, 
 when the cleansing is done, it should immediately be well dried, 
 and its clothes restored as quickly as possible ; 3dly, in cold 
 weather, the water should be rather warmer than in hot wea- 
 ther ; 4thly, a little fine soap should always be used, by pre- 
 viously dissolving. a small portion in the water, before it is em- 
 ployed, especially for the lower half of the body; 5thly, the 
 head, particularly if the child be very young, should be first 
 washed, dried, and its cap put on, before the other portions of 
 the body are wetted ; 6thly, children should never be dressed in 
 ■a current of air ; 7thly, they should never be roused from their 
 sleep for this purpose, nor washed immediately after walking ; 
 but they may safely be permitted to sleep, after the fatigue of 
 dressing. 
 
 83Q. When the conveniences present themselves, children of 
 both sexes should be permitted, under proper regulations of de- 
 cency, to bathe in running streams, ponds of pure water j, or rivers, 
 during the warm weather of summer. But this should always be 
 ,done under the superintendence of adults qualified to protect them 
 against accident. They may thus be instructed in "that most 
 useful exercise, and art, swimming, of which no boy, (and why 
 may we not add, girl ?) should be ignorant after their ninth year. 
 It is an important part of education, that youth be taught to 
 swim ; and we regret, that hitherto, no proper establishment of 
 this kind has arisen among us. The one purporting to be for this 
 purpose, has too many serious objections against it, to receive 
 general patronage. In the first place, it is not conducted with 
 
 * Treatise, p. 353. 
 
OF DRESS. 249 
 
 sufficient decency ; secondly, it is badly situated for the pur- 
 pose; and, thirdly, it is much too expensive. 
 
 831 . We have employed the words bathing, and washing sy- 
 nonymously in our present chapter. We think it necessary to 
 explain this ; as in no instance have we wished to be under- 
 stood submersion, by the term bathing, and when we have spoken 
 of washing, it always had reference to the whole body undei go- 
 ing this discipline, in distinction to the partial cleansing of the 
 hands and face. 
 
 CHAPTER XIII. 
 
 OF DRESS. 
 
 832. We have already spoken of dress, when applied to chil- 
 dren of the first period — that is, from birth to weaning. We 
 shall now say a few words upon this important point, from that 
 time to the age of puberty. 
 
 833. The object of all dress should be, first, to cover the body 
 in such a manner that decency shall not be violated ; and se- 
 condly, to protect the body against the vicissitudes of the seasons. 
 
 834. The first object may be easily obtained ; and this by the 
 most simple means — to accomplish which, it is only necessary to 
 cover the body with a loose garment, of sufficient length and 
 width. But this simple plan is rarely adopted ; as caprice and 
 fashion, pride and ostentation, are constantly interfering with it ; 
 — hence, the immense variety of dress observed in the "different 
 portions of the globe, as well as in contiguous places. Where a 
 departure from the simplicity just spoken of, does not injure by 
 imposing restraint upon either the limbs or body, it is not a legiti- 
 mate object for animadversion ; since causes beyond our control 
 will constantly be operating, to produce great variety in the form 
 of dress. 
 
 835. The mischievous and preposterous custom of swaddling 
 is nearly abolished, in almost every part of the world: the child, 
 from its birth, being now permitted more freedom for its limbs, 
 which it exercises, accordingly, with much advantage to itself. 
 
 32 
 
250 OF DRESS. 
 
 But in fulfilling the second object, namely, a protection against 
 the weather, many errors are committed — first, in the form of 
 the garments, and, secondly, in the quantity and quality of them. 
 
 Sect. 1. — The Form of the Garments. 
 
 836. To a certain period, say until the fourth or fifth year, it 
 is usual to habit both the male and female child pretty much af- 
 ter the same manner ; and, luckily, when this plan was adopted, 
 the dress of the male was made to conform to that of the female 
 — we say luckily, for so truly it was ; since the dress of the lat- 
 ter, in modern days, is much better calculated for both health and 
 comfort, than that of the former. The loose style of dress now 
 adopted for children, if persevered in, will certainly be of much 
 consequence to the rising generation, since it imposes no restraint 
 either upon the extremities or the abdomen. . The stiff stays for 
 female, and the tight waistbands of breeches for male, children, 
 formerly in use, have now yielded to the unconfined frock, and 
 petticoats in the one, and the modern invention of trousers and 
 suspenders in the other. By these changes, a greater security 
 is afforded for the preservation of health, since neither the chest 
 nor abdomen in girls, nor the abdomen and lower extremities 
 in boys, suffer from compression. 
 
 837. We have already adverted to the evils which may arise 
 from too great a pressure upon the abdomen, when speaking of 
 the belly-band of infants ; and it may now be proper to observe, 
 that our observations upon this point are not confined to that pe- 
 riod of life — they extend, properly speaking, to every period ; 
 and will apply with much force to the stage of life we are now 
 considering. Indeed, we might say, with more force, since, 
 joined to the pressure so earnestly deprecated, we must add, the 
 almost incessant muscular exertion to which children yield them- 
 selves at this particular time, by which the liability to rupture 
 must be increased ; and especially, at this time, the parts give 
 way with proportionable facility. 
 
 838. We, therefore, consider the loose dress now in use for fe- 
 males, and the almost universal recourse to trousers and sus- 
 penders, for boys, as contributing much to their general health, 
 besides very much diminishing the risk of the accident, at which 
 
OF DRESS. . * 251 
 
 we just hinted. On these accounts, we would earnestly recom- 
 mend it to every mother, so to dress her children, as shall pre- 
 vent every possible risk of too strong a pressure upon the parts 
 designated. 
 
 Sect. II. — The Quantity, and Quality of Clothing. 
 
 839. The errors committed on both these points, are not less 
 frequent than obvious; they consist chiefly in extremes: theory 
 in most instances directs both ; and too often in direct violation 
 of reason and experience. One extreme here alluded to, is ad- 
 vocated by a class, who suppose that the body can scarcely be 
 covered too thinly, for the purposes of giving strength to the 
 constitution ; hence, let the inclemency of the weather be what 
 it may, they banish nearly all the warmer articles of clothing, 
 with the view of inuring the body to any temperature to which 
 it may be exposed. The other class consists of those who ap- 
 prehend cold to be the most destructive agent that the human 
 body has to contend against ; hence, whenever their pupils are 
 exposed to an out-door atmosphere of reduced temperature, care 
 is taken to protect them against the mischievous tendencies 
 which their apprehensions have conjured up, by every adven- 
 titious means that wool and fur can supply. Both these plans 
 must, necessarily, have their victims; and it is, perhaps, a moot 
 point, which of the two is the most destructive. We have al- 
 ready dwelt upon this subject, on another occasion ; and what 
 we have said there, will strictly apply here. 
 
 840. Our mutable climate, or rather our climate, which at 
 one season has the heat of the tropics, and in the other the cold 
 of the frozen north, requires corresponding changes in clothing, 
 at those different periods. In summer, our feelings oblige us to 
 reject all superfluous covering; and, in winter, they make us 
 covet the warmest garments — there is but little risk, in gene- 
 ral, in obeying the first impulse ; but the second may be car- 
 ried to an extreme, especially in the early part of life. 
 
 841. Exercise, which is so much desired by youth, and which 
 is generally so advantageous, will render less warm clothing, 
 even during our coldest periods, sufficient; hence, those who are 
 habitually exposed to the weather, but at the same time sufficient- 
 ly well protected, will require either fewer garments/or of less 
 
252 OF DRESS.. 
 
 • 
 
 warm materials, than those who are almost constantly confined 
 to the house, either from necessity or choice : nor will the for- 
 mer be so liable to injuries from the vicissitudes of the weather. 
 
 842. This fact is notorious to the observation of every body; 
 yet so unnecessarily apprehensive are some, that they oblige 
 their children to clothe themselves as warmly, when they are 
 in the full exercise of their limbs at their various sports or avo- . 
 cations, as if they w r ere about to perform a journey in a, slow- 
 motioned stage-coach or wagon. The consequence of this over- 
 clothing, under such circumstances, are, croup, pleurisy, or ca- 
 tarrhal fever, from a suddenly checked perspiration, which had 
 most unnecessarily been excited by a superfluous quantity of 
 clothes. We have already remarked upon the other extreme. 
 
 843. Too strictly guarding the neck and throat of boys, should 
 be particularly avoided ; for, from the proximity to the seat of 
 circulation, they very quickly have their heat unduly increased 
 by an over quantity of covering ; to relieve which, the articles * 
 surrounding them, are suddenly removed, perspiration becomes 
 checked, and disease, of course, follows. Therefore, those parts 
 should be but moderately clothed, that the consequences just 
 spoken of may not follow. 
 
 844. Custom, among females, has almost deprived them of 
 any protection to these parts, or even to their chests. This ex- 
 posure to an inclement atmosphere is decidedly wrong; and but 
 too often lays the foundation of consumption, or other affections 
 of the chest, (459.) We are, however, not to be understood as 
 advising any unnecessary covering; we would only wish to 
 suggest, that when they are exposed to the weather, a greater 
 protection should be afforded to these parts, than if they were 
 within doors. 
 
 845. The head should not be too warmly clad, of either a boy 
 or girl, especially those who are in the habit of exercising much 
 in the open air — nature intended that the hair should serve for 
 its protection, particularly within doors. Therefore, children" 
 should not be permitted to wear their hats or bonnets in the 
 house, as there the hair is an all-sufficient covering. Jn the ex- 
 treme cold of winter, the ears of such as are exposed to the 
 wind frequently suffer severely — to prevent this, a small piece 
 of fur may be adjusted to the hat, so as to cover these parts ; 
 or a fur cap may be indulged in, but let it be forbidden to be 
 worn in the house. 
 
OF DRESS. 253 
 
 846. But in no one particular are the sticklers for the hard- 
 ening system more in error, than when they reject stockings in 
 cold weather, and even in winter. We cannot refrain from ex- 
 pressing our surprise, that this absurd and cruel practice could 
 ever obtain, since there are no portions of the body more liable 
 to suffer than the feet and legs, and few that have a larger cir- 
 cle of sympathies connected with them. We, therefore, con- 
 stantly recommend, that these parts should be kept covered by 
 a sufficient protection by stockings and shoes. We say that a 
 sufficient protection should be given to these parts ; for we are 
 aware, that, like the coverings for other parts of the body, it 
 may be overdone. In winter, the shoes can scarcely be too 
 stout ; not by their thickness to increase warmth, but to protect 
 the feet against wet. The stocking may be of worsted ; but 
 these should not be too thick. If the stockings be too thick, 
 they excite too much perspiration, and the consequence is, cold 
 feet. 
 
 847. We have already remarked upon the propriety of keep- 
 ing young children sufficiently warm in every respect ; and of 
 the necessity of accommodating their clothing to the vicissitudes 
 of the weather ; but we do not wish to be understood, that this 
 system should be extended in all its details to children of greater 
 age— that is, to children of the period of which we are now 
 treating ; for, after the fifth year, it is well to inure them to the 
 changes of an external atmosphere, by often repeated, but not 
 too long continued exposures. A person of but common obser- 
 vation, who has an interest in the child, will easily perceive 
 when the cold becomes severe, by its complainings, as well as 
 by its appearance — when this happens, the child should be im- 
 mediately removed to a milder, but not suddenly to a heated at- 
 mosphere. In these little, but important trials, the child should 
 never remain passive for any length of time — if not of itself dis- 
 posed, it should be induced by various little stratagems, which 
 every good nurse is acquainted with, to put its little body in 
 motion, that the circulation may be equally maintained ; but if 
 it cannot be excited to activity, let it be taken into the house. 
 
PART III, 
 
 CHAPTER I. 
 
 OBSERVANCES, FROM SECOND DENTITION TO 
 PUBERTY. 
 
 848. It is impossible to treat this part of our subject, with- 
 out constant reference to certain directions which have already 
 been given, for the promotion of the general well being of the 
 child. Up to the period, therefore, now about to be considered, 
 we are supposed to have directed the best physical treatment in 
 our power ; that is, we have endeavoured to avail ourselves of 
 the experience of others, as well as of our own, to give the best 
 possible chance of a healthy, regular development of the system, 
 by urging such observances and directions, as have been found 
 best calculated for this important purpose. 
 
 849. We shall not, therefore, repeat in detail, the directions 
 for eating, drinking, sleeping, exercise, &c. ; but merely state, 
 that, as the body is still in a state of gradual development, as 
 much care is necessary at this period, for the continuance of 
 the system already commenced, as was in the earlier parts of 
 life. Indeed, it may be said with much propriety, that as the 
 individual is now left more to his own guidance from his in- 
 crease of years, it behooves him, by cautious conduct, that he 
 defeat not the good already received from the government of 
 watchful parents, and thus irretrievably destroy his health. 
 Boys, at this period of lffe, are necessarily less under the eye 
 of the parent than girls ; consequently, more vigilance is required 
 with regard to them. To render, therefore, any directions ef- 
 ficient, such a habit of obedience must have been created by 
 previous moral discipline, as will render the will or commands of 
 the parent availing; or all that has been before done, will be lost. 
 
FROM SECOND DENTITION TO PUBERTY. 255 
 
 850. Should children, from heedlessness, or perverseness at 
 this period of life, fail to continue the plan previously adopted 
 for their benefit, they will be sure either to call into action some 
 latent predisposition, if such exist, or lay the foundation for fu- 
 ture ill health ; as this period, like that of dentition, is marked 
 by peculiar susceptibilities, and is thus rendered more obnox- 
 ious to disease. We shall, therefore, say a few words upon the 
 leading points of physical education, that we may not be mis- 
 understood in respect to that we would wish to enforce ; and, 
 
 851. 1. Of Eating. — If the physical treatment have been pre- 
 viously well begun, it will be found, at this time, that the appe- 
 tite and digestion, will be in just proportion; for the body has 
 now acquired more vigour ; and the play of the muscular sys- 
 tem is more confirmed, and better balanced ; consequently, the 
 stomach will have an increase of power, and will perform its 
 offices with as much facility as success, provided it be not over- * 
 taxed by the quantity of food, or that this be not of an impro- 
 per quality. But, unfortunately for this period of life, children, 
 as we have already observed, are less under the eye of the pa- 
 rent, and are but too apt to abuse this organ, either from a cer- 
 tain craving for improper articles, or a recklessness of conse- 
 quences, however affectionately forewarned — hence, but too 
 often, a foundation is now laid for future disease of the stomach. 
 Sometimes, indeed, parents themselves are not sufficiently upon 
 their guard ; they permit, but too often, the full indulgence of 
 the appetite, from a persuasion, or rather from an unfounded hy- 
 pothesis, that " children never eat more than is good for them." 
 
 852. This unqualified assertion is contradicted by daily expe- 
 rience ; and, therefore, deserves the serious consideration of pa- 
 rents. They should learn to distinguish between the demand 
 of a natural and healthy appetite, and the cravings of habit ; or 
 they will discover, too late, that the powers of the long-suffer- 
 ing stomach are destroyed, never again to be restored. There 
 is no point of treatment more easily complied with than this, 
 provided the parent, or a judicious and faithful servant, take 
 charge of the child during its meals, and become the judge of 
 both quantity and quality. We shall, therefore, lay down the 
 following rules for eating : — 
 
 853. (a) Children should never be suffered to eat alone, un- 
 less the proper quantity of food be apportioned to them. 
 
25G OF EATING. 
 
 854. (6) If a child demand more than is judged proper for it, 
 resist, at once, its importunities with firmness, or you will but too 
 certainly make a glutton. 
 
 855. (c) As every extraordinary article becomes a new in- 
 centive to appetite, as little variety as possible should be set be- 
 fore children. 
 
 856. {d) Children should never be indulged with a second 
 course ; since, if they sit down with an appetite, they will gene- 
 rally satisfy it, by eating freely of the first article presented to 
 them ; consequently, all the rest is superfluous, and, therefore, 
 injurious. If the appetite be small, the less they eat at that 
 moment the better; as, by taking but little, the appetite will be 
 sure to return at the n^xt meal. But, should this instinct of na- 
 ture for an observance of moderation be neglected, or be at- 
 tempted to be overcome by variety, repletion, with all its evils, 
 will follow ; therefore, instead of a renewed and healthy appe- 
 tite following, as it would necessarily have done, had the instinct 
 been obeyed, it will be found diminished; and most probably at- 
 tended with headach, oppression, or even vomiting. 
 
 857. (e) The food for children at this period, should be of the 
 most simple, and digestive kind. The breakfast should be of 
 milk with bread, mush, rice, &c; or, of very weak tea, with 
 much milk, bread and butter, and a soft-boiled egg. The din- 
 ner may consist of plain boiled or roasted beef, mutton, chicken, 
 &c, or the soup of either, divested of fat. The vegetable, (for 
 there should never be more than one at a time,) may be the 
 Irish potato, rice, hommony, Lima beens, or beets. This plain 
 food will be every way sufficient for all useful purposes: — more 
 than this will be excess, and should, therefore, be prohibited. 
 The supper should be similar to the breakfast. 
 
 858: (/) Children should never be indulged with pastry of 
 any kind — they may, occasionally, take a little of the cooked 
 fruit of a pie, but even this should be used moderately. 
 
 859. (g) Children should not be indulged with bread, bread 
 and butter, &c, between meals, however hungry they may seem 
 to be : for this will either destroy the regular appetite at dinner, 
 or they will eat too much. In the first case, the stomach will 
 be interrupted in the regular routine of its functions ; consequent- 
 ly, the appetite will become either irregular or whimsical; both of 
 
OF EATING. 257 
 
 which must be avoided; in the second case, all tbe evils conse- 
 quent upon an over-distended stomach must follow. 
 
 860. (h) Children should never be permitted to exercise vio- 
 lently immediately after dinner ; therefore, this meal should be 
 presented to them soon after school hours; and they should be 
 made to remain passive; or, at least, all severe exercise should 
 be forbidden, until they return to their school. 
 
 861. (i) Children should be taught the importance of eating 
 slowly, and chewing their food well — on this account, a habit of 
 resting after eating should be early established, that they need 
 not swallow their meals hastily to return to play ; or, in other 
 words, this should never be permitted. 
 
 862. (k) Children of the age of which we are speaking, may 
 occasionally be indulged in small quantities of almost any of our 
 fruits, provided they be perfectly ripe.* The most proper time 
 for this, is when the stomach is in full possession of its powers, 
 or an hour before dinner. The reason for the selection of this 
 time, is obvious : the stomach is now empty or nearly so, and 
 the gastric juice is in considerable quantity; for we have already 
 observed, that fruit is not very easily assimilated. 
 
 863. (I) Children should not be suffered to carry food in their 
 pockets, to eat between meals, or during school hours ; as the bad 
 habit of requiring food at improper times is produced, and the 
 digestion of the previous meal is interfered with, by a fresh 
 quantity being thrust into the stomach, before it has properly 
 digested that which had before been received. 
 
 * Children at the period of life just named, are more frequently and seriously 
 injured by eating- unripe fruit, than is generally imagined. There is, to a child's 
 stomach, an irresistible charm in fruit of every description; and they will but too 
 often procure it, coute qui coute. Having no guide but their inclination, they will 
 eat of it even to surfeit, if able to procure it. Parental admonition would effec* 
 much on this important point, were it enforced by command, or even strengthened 
 by example; but, unfortunately, too many parents are either indifferent to what 
 their children eat, or think it right they " should bie able to eat of any thing.'' It 
 is in vain, then, to rely upon parental authority to remedy this evil; we must look 
 to the civil power, for its cure; and it is truly an object worthy of their most serious 
 deliberation, to remove, by a law regularly and severely enforced, all the unripe 
 trash, which so abundantly fills our market. Eveiy kind of fruit offered for sale, 
 should be rigidly inspected; and if it be found immature, it should not only be 
 forfeited, but the vender severely fined — this would effect much more good than 
 the seizure of a pound of butter, because it lacks half an ounce of the standard 
 weight. 
 
 33 
 
258 OF EATING, DRINKING, SLFEPING. 
 
 864. (m) Children should get their breakfast as soon after they 
 have properly washed, and combed themselves, as may be — as 
 their stomachs are now empty, and plentifully supplied with gas- 
 tric liquor. If left too long without food, the cravings become 
 either too importunate, or the appetite fails — either of which 
 would be injurious. 
 
 865. 2. Drinking. — There is but one drink really proper for 
 children ; namely, water. In this they may be as freely indulged 
 as the necessities of the stomach may require; but they ought 
 not to be permitted, upon every pretence, to .drink between 
 meals, lest a disagreeable and mischievous habit be generated, 
 and the stomach made to suffer. During meals, or soon after, 
 they may drink water to advantage; but to encourage the habit 
 of drinking between every mouthful they swallow, is bad. The 
 stomach becomes unnessarily distended by quantity, and dis- 
 tressed by weight; and the digestive menstruum impaired in 
 power, by over dilution; consequently, the process of assimila- 
 tion will be imperfectly performed. 
 
 866. 3. Sleeping. — This all-important restorative, should be 
 regulated with the utmost care. Its periods should be disturbed 
 as seldom as possible ; and the child should be permitted to en- 
 joy its full proportion, and this without interruption, if possible, 
 Some children require more sleep than others; it is, therefore, a 
 useful study to ascertain the proper quantity each individual 
 should employ. To determine this, we must be attentive to the 
 habits of every child; and that one, which expends, by any 
 means whatever, the most strength during the day, requires 
 most sleep during the night to restore the lost quantity. We 
 may, therefore, lay down the following rules for sleeping. 
 
 867. (a) Every child should go early to bed, that the due 
 quantity of sleep may be certainly procured — by early we mean 
 immediately after candle light in summer, and not later than 
 eight or nine in winter; for a child not exceeding seven; and a 
 little later for one more advanced.* 
 
 * It would be difficult to fix, by hours, the precise time a child should sleep, 
 as it must, in some measure, depend upon constitution, as well as upon exercise 
 and mental exertion. In general, we may say, that a child of seven years old 
 might safely indulge in nine hours of sleep; and from that period to manhood 
 .eight hours may be safely allowed. 
 
OF SLEEPING. 259 
 
 8G8. (b) Sleep should be so regulated as not to interfere too 
 much with the hours after daylight — therefore, the old saw of 
 " early to bed, and early to rise," &c, is one of great moral 
 meaning, and of great practical usefulness.* 
 
 889. (c) Children should not, however, be put to bed immedi- 
 ately after a full meal —it would be proper, if any thing has 
 prevented its taking supper at the regular and proper time, that 
 the sleeping hour be a little retarded. 
 
 870. (d) Children should never be unnecessarily or suddenly 
 awakened, lest their nervous system be thrown into disorder by 
 the alarm. 
 
 871. (e) Children should be early accustomed to sleep in the 
 dark, both from a moral and physical propriety — they should 
 not fear the dark; nor should their sleep be interrupted by the 
 presence of light. 
 
 872. (/) Children should not be permitted to indulge in bed 
 long after daylight: as its warmth, the accumulation of urine 
 and faeces, and the exercise of the imagination, but too often 
 lead to the precocious development of the sexual instinct. 
 
 873. Sleep is not only useful in restoring lost energy; it is, 
 also, highly important to growth. It is a well established fact, 
 that there is a considerable difference in the stature, especially 
 of young people, between the morning and evening. This arises- 
 from the superincumbent weight producing an -approximation of 
 the vertebrae: consequently, an opportunity should be given to 
 them to expand again, which they will do by their own elasti- 
 city, as soon as they have the opportunity, by the weight of the 
 body being taken off by a recumbent posture. 
 
 874. 4. Exercise. — In proportion as the child advances in age r 
 will be his desire for employment ; hence, the multiplication of 
 his amusements. Every proper opportunity, therefore, should 
 be given, for the due exercise of both body and mind ; but nei- 
 ther should be too much fatigued. Care should be taken, at this 
 period, to provide such employment or amusement, as shall ex- 
 ercise the arms as well as the limbs ; of this kind is battledore and. 
 
 * Children should not be played with after they are in bed; sleep, like every 
 other function of the body, has its periods: should this be incautiously interrupt- 
 ed, tiie child may remain wakeful during the whole night, and be thus unfitted 
 to rise in proper lime in the morning. 
 
260 OF EXEKCISE. 
 
 shuttlecock, playing at ball, pitching of quoits, &c, for the pe- 
 riod is now fast advancing for the completion of the human 
 body ; and its proper development very much depends upon uni- 
 form exercise. * Therefore, all such, employments as but par- 
 tially employ the muscular system, should be changed, for those 
 which will call in requisition every part of the frame. 
 
 875. After selecting proper games and exercises for children, 
 constant care should be taken, that none are indulged in to ex- 
 cess ; for, the most innocent and amusing, if carried too far, 
 may become a source of extensive mischief; therefore, amuse- 
 ments of every kind may be converted into evils. But let us 
 not deny ourselves the advantage of such employments, because 
 they may be abused. Let us only be judicious in choice, and 
 set proper bounds to indulgence, and there is little to fear from 
 the exercises of youth. 
 
 876. Again, in choosing amusements, let them be well adapted 
 to the individual for whose benefit they are intended— thus, eve- 
 ry boy cannot become a good fencer, a good dancer, a good 
 runner, and a good leaper ; yet he may excel in some of these 
 amusements. His disposition, and skill for any particular spe- 
 cies of amusement should be studied ; and he should only be 
 kept at such, as will give him a chance of not falling below medi- 
 ocrity. If this be not attended to, he may become listless, and 
 supine; and receive injury from that, which was well calcu- 
 lated for his benefit, by his self-love being mortified, by the su- 
 perior skill and address of his companions. 
 
 877. All hazardous experiments of skill, or strength, should 
 be peremptorily forbidden— all attempts at posture-making, are 
 highly dangerous, and should not be reckoned among the proper 
 exercises of youth. Every violent exertion must, necessarily, 
 be attended by a proportional strain upon some one part or 
 other of the body; therefore, it should be instantly discounte- 
 nanced; such as jumping from great heights, leaping over ele- 
 vations, lifting great weights, ccc; for,.in every exertion of this 
 kind, the most serious risks are run, of producing a disability 
 for life. It is by these hazardous experiments, that " ruptures'' 
 are so frequently produced. 
 
 878. We should, nevertheless, be careful, that we* do not pro- 
 duce timidity by the too indiscriminate reprehension of amuse- 
 ments, which maybe abused; children should be permitted to leap. 
 
OF EXERCISE. ' 261 
 
 climb, or run, to a certain extent ; but only where, under ordina- 
 ry circumstances, no danger can arise. At the same time, they 
 should be made acquainted with the mischief which may follow 
 any of these amusements, when carried to excess, or when im- 
 properly performed. They should be early made sensible, that 
 lifting weights beyond their strength, throwing the body violent- 
 ly, and extensively backward, leaping over high places, or 
 jumping down very low ones, &c, may in a moment produce 
 a " rupture," and disqualify them through life for any active 
 employment. On this account, the exercises of a well regu- 
 lated gymnasium become so valuable, as the performances are^ 
 graduated ; beginning with the most easy, and progressively 
 arriving at the more difficult. 
 
 879. Very often, at this period of life, strong dispositions are 
 discovered for mechanical employments : whenever these are of 
 a decisive character, they should be encouraged ; for, though 
 the individual may never follow the art his early predilection 
 led him to select, 3^et, the dexterity acquired in his early years, 
 may essentially serve him in some future business of life ; thus, 
 a surgeon has been often benefited, by his knowledge of the 
 mode of handling tools, &c. Therefore, a , boy may often safe- 
 ly and profitably be indulged in the use of sharp tools, though 
 it may occasion an anxious mother many heart-aches, during- 
 his initiation into the mode of employing them. 
 
 880. One general, and we might say essential rule, should 
 ever"govern youth in their sports and amusements ; which is, 
 never to engage in such as shall require much exertion, after a 
 full meal, as the worst consequences may result from the ne- 
 glect of this caution. 
 
 881. It will be perceived, that the great object of all physical 
 education is, the regular and healthy development, of every part 
 of the body, in its proper order and proportion. When this suc- 
 ceeds, the period of puberty advances in regular and unembar- 
 rassed order ; and the intentions of nature are fulfilled without 
 disturbance, or disease. The changes in both sexes, intended 
 to mark this important period, take place in regular succession ; 
 and when accomplished, mark a new era in human life. And 
 most happy should that individual be, who arrives at this period 
 without accident, and proves the changes to be complete. 
 
 832. Much care is required, at this all-important time, that 
 
202 OF EXERCISE. 
 
 neither accident nor design shall interrupt the regular march of 
 changes, which precede and announce the completion of the hu- 
 man fabric to be at hand. Jt is a period replete with moral and 
 physical difficulties ; and much prudence, and good sense are- 
 required on the part of parents and guardians, that they may 
 be both successfully surmounted. It does not enter into our 
 scheme, to treat this subject either anatomically, by tracing the 
 alterations of structure in the parts mediately or immediately 
 concerned ; or medically, by pointing out the diseases and 
 their cure, to which they may be liable. 
 
 883. Though it does not enter into our scheme to treat of the 
 moral discipline of youth, yet we may be permitted to observe, 
 that much injury is done to them, especially in the very early 
 period of their existence, by attempts at precocious development 
 of the mental powers, by overtaxing the brain, by presenting to 
 it tasks, fitted only for riper years. This injurious exercise of 
 the mental powers, originates in either a mistaken theory, or in 
 a vanity, on the part of the parent, that cannot be too severely 
 reprehended. 
 
 8S4. We once saw a child of twenty months old, completely 
 master of the alphabet — it was a female, and began to talk very 
 early; its mother, by a perseverance and industry worthy of a 
 better object, commenced her task of teaching as soon as the 
 child could speak ; and, before it was twenty months old, it 
 knew every letter of the alphabet so well, as not to be puzzled 
 by any stratagem instituted to mislead it. She died a prodigy,. 
 at three years old, of hydrocephalus internus, or dropsy of the 
 brain. This victim of maternal pride, was constantly exhibited 
 to every visiter, and made to give proof of its precocious attain- 
 ments, until its little brain could no longer resist the repeated 
 shocks it was forced to bear, for the gratification of the mis- 
 taken mother's vanitv, or to ffive evidence of its intellectual 
 powers. 
 
 885. To this, we may add another error into which parents 
 permit their children to indulge at a very early period of life, 
 and which, with certainty, lays the foundation of many gastric 
 as well as cerebral affections — namely, the use of tobacco in 
 some way or other. On this subject, we cannot resist the temp- 
 tation to copy Dr. Palmer's eloquent denunciation against the 
 use of cigars. 
 
 886. " The young man, who, unjustified by the [ilea of ill 
 
OF EXERCISE. 263 
 
 health, or -unsanctioned by the prescription of his physician, has 
 acquired the habit of smoking a pipe or cigar, may assuredly 
 congratulate himself on having reached the second stage of his 
 progress, from temperance to dissipation — from elasticity of spi- 
 rit and vigour of frame, to premature imbecility and decay. As 
 the reckless poacher is led gradually on, from his work of mid- 
 night depredation in the woods, to more daring acts of violence 
 and rapine; so will the youthful smoker be too often insensibly 
 allured from a wanton indulgence in the cigar to the sins of in- 
 toxication, and the ultimate sacrifice of his health, his charac- 
 ter, and prospects. Let parents, then, as they appreciate the 
 responsibility which devolves upon them, solemnly protest 
 against, and resist the first encroachment of this pernicious ha- 
 bit in their family. Let females, whose influence is commonly 
 as beneficent as irresistible, exert their powers in decrying the 
 noxious practice, and averting from those in whose reputation 
 and welfare they are so deeply interested, the moral pestilence. 
 If the leaders of fashion in the land are resolutely bent on de- 
 stroying the little remnant of energy and character which they 
 still possess, let them pursue their ignoble propensities, and 
 achieve the work of moral ruin, as they are wont to dissipate 
 their fortunes, in private. Society will be disposed to contem- 
 plate with singular philosophy and forgiveness, any act of mo- 
 ral suicide which these * Spoilers of the human hive,' may be 
 tempted to commit. But let them not contaminate with noxious 
 exhalations, the public atmosphere; nor the minds of the thought- 
 less and inexperienced, who are, too frequently, by the vulgar 
 ambition of aping fashionable follies, with their yet more pesti- 
 lent example. " — Illustrations of Medieine, p. 145. 
 
OF THE 
 
 DISEASES OF CHILDREN, 
 
 34 
 
PREFACE. 
 
 The diseases of childhood have not, until lately, sufficiently 
 engaged the attention of physicians, though they have strongly 
 claimed it. It would be difficult to explain satisfactorily, the 
 causes of this indifference ; it may, however, we believe, chiefly 
 be ascribed to the following facts : ] st, To the practice of mid- 
 wifery being confined almost exclusively to women, until within 
 the last fifty or sixty years ; by which the physician was thus 
 prevented from seeing, many of the diseases of children. 2dly, 
 In Great Britain, especially, to a by-law of the Royal College 
 of Physicians, " by which its fellows are compelled to exclude 
 themselves from practising midwifery," thereby operating like 
 the first cause. 3dly, To a belief that the diseases of childhood 
 are obscure, or even unintelligible. 4thly, To parents supposing 
 that nurses and old women are more conversant with these dis- 
 eases than the most enlightened physician ; by which they are 
 deprived of the opportunity of studying them with as much di- 
 ligence and accuracy, as they deserve. 
 
 But, fortunately for this class of sufferers, an almost entire 
 change has been effected within the years just stated, by the 
 practice of midwifery becoming almost entirely confided to the 
 physician ; by the public mind inclining to the belief that the 
 diseases of infancy may be understood, by due attention and 
 study ; and, also, that there is rather more safety in the pre- 
 scriptions of the physician, than in those of the nurse. 
 
 In consequence of this alteration in public sentiment, the 
 care of the diseases of childhood has been committed to the 
 physician; who now has the opportunity of watching them 
 through all their changes, from the moment of birth, to the pe- 
 riod of puberty. Hence, we have, within the last few years, 
 some valuable treatises upon this subject ; so many, indeed, that 
 
II PREFACE. 
 
 it may appear to some, to lead to the conclusion that the sub- 
 ject is exhausted. Under this impression, the present under- 
 taking may be thought to be unnecessary, or, at least, to require 
 apology. 
 
 In our defence, therefore, we shall merely observe, that the 
 science of medicine must necessarily be a progressive one ; and 
 that its advancement must mainly depend upon the improve- 
 ments its respective followers may make, in the exercise of its 
 various departments ; consequently, each one is bound to contri- 
 bute his mite towards the general benefit. But, as the improve- 
 ments of any individual in the treatment of one or more of the 
 complaints of childhood, would scarcely justify the writing of a 
 volume to announce them; as they are, for the most part, diffused 
 through the journals of the day ; it follows, it must become the 
 office of some one, to collect and imbody them, that they may 
 not be lost, and, by such loss, society sustain an injury. 
 
 This office has been undertaken by us ; but with what success 
 must be determined by others. We hope we are not indulging 
 an overweening vanity, when we say, we feel ourselves, to a 
 certain extent, qualified for this duty ; since more than forty 
 years of our life have been spent in the contemplation of dis- 
 eases; and those of- childhood have claimed a large share of 
 our attention during that period. 
 
 We may urge another inducement to this undertaking; name- 
 ly, that, hitherto, no one on this side the Atlantic has thought 
 proper to give to the public at one view the American practice 
 in the diseases of children. This supineness of our physicians 
 is no less surprising than reprehensible ; especially as many are 
 so well qualified by their talents and experience for the task ; 
 and, moreover, as such strong inducement is constantly held out, 
 by the peculiar character of our diseases; and, in many in- 
 stances, by the novelty and boldness of the mode of treatment. 
 
 Hitherto, we have almost exclusively depended upon Euro- 
 pean publications for information upon almost every subject 
 connected with medical science ; and we acknowledge we have 
 received much advantage from them ; especially from their 
 elementary works : but it must not be disguised, that the same 
 advantage has not been derived from all their practical works. 
 This has not arisen,from a deficiency of either opportunity or 
 of talent ; for we confess both, in many instances, to have been 
 great; but to the want of proper adaptation of their remedies to 
 
 > 
 
\ 
 
 PREFACE. iii 
 
 the state, force, and peculiarity of our diseases. For it cannot 
 escape the observation of any intelligent practitioner who may 
 have visited both countries, how essentially our diseases are 
 modified by climate, soil, manners, and habits ; and that these 
 modifications require corresponding changes of treatment. 
 
 Most of the diseases of this country have a peculiarity of cha- 
 racter, an intensity of force, and a rapidity of march, altogether 
 unknown to European climates ; and, were reliance to be placed 
 upon the feeble practice of that portion of the globe, however 
 well suited to the state of its diseases, we would but too often 
 have the mortification to see our patients hurried to an untimely 
 tomb. 
 
 The diseases of childhood in this country, like those of adult 
 age, require to be met with promptitude, and with adequate 
 means ; a temporizing treatment suits not their character, and 
 if adopted is almost sure to end in defeat.* 
 
 Besides, the catalogue of diseases of children by European 
 writers, has, in our opinion, been too much extended ; at least 
 for this country. Many of the diseases enumerated by Under- 
 wood, who is certainly one of the best writers upon this sub- 
 ject, are entirely unknown here ; the study of them, therefore, 
 becomes unnecessary, if not mischievous ; since, from the enu- 
 meration of some general symptoms, one disease may be mis- 
 taken for another ; or, from an overweening desire of accuracy, 
 and classification, confusion may be produced ; or distinctions 
 without differences may be made. This is particularly the case 
 with the diseases of the skin. 
 
 In our account of the diseases of childhood, we have en- 
 deavoured to separate the accidental from the characteristic, 
 or permanent symptoms ; and have only detailed such, as are 
 known to accompany the disease in this country. This determi- 
 nation has almost necessarily confined us to the history and 
 treatment of such diseases only as exist in this country ; and 
 especially to those in this part of our continent. Therefore, 
 the history of the diseases to which children in Philadelphia 
 and its neighbourhood are liable, will be, we are of opinion, a 
 pretty faithful account of almost all in this country ; since the 
 
 • This declaration applies rather to the necessity of early attention to tiie dis- 
 eases of our climate, than to any great difference in the nature of the therapeuti* 
 cal means. 
 
IV PREFACE. 
 
 heat of our summers will have nearly as decided an influence 
 upon their constitutions, as the sun of the Carolinas or Georgia ; 
 while the cold of our winters will produce consequences analo- 
 gous to those of more northern latitudes. 
 
 At all events, very little mischief can arise from this mode of 
 treating our subject ; and none, which cannot be immediately 
 repaired by any well instructed practitioner ; for it will entirely 
 consist in the proper adaptation of the remedy, to the force of 
 the disease, taking it for granted he understand its character ; 
 and in this country this is generally so uniform, as not to make 
 him liable to much error. 
 
 Indeed, we may safely add, that the general simplicity of the 
 diseases of children, renders their management more easy, as 
 well as more certain than those of adults ; their complaints are 
 almost always acute, and of the sthenic kind; hence the ne- 
 cessity and success of evacuations, in almost all of them. . 
 
 We are fully aware, that the opinion just advanced, is not the 
 pupular belief ; particularly in Europe ; and especially since the 
 promulgation of the doctrines of the ingenious, but ill-fated 
 Brown. He taught, and it is but too generally believed, that 
 their diseases were almost always asthenic, and, of course, bore 
 evacuations ill. There is,'perhaps, no one error in medical 
 science greater, or more mischievous than this ; — to it must be 
 attributed, mainly, the general want of success in the com- 
 plaints of childhood ; and the frequent difficulties the physician 
 has to encounter in his treatment of them, from the interposition 
 of such parents and friends, as may have imbibed the same pre- 
 judices. 
 
 The experience of every day would prove, how well children 
 support long-continued evacuations, did we not turn our eyes 
 from the useful lesson. Who has not witnessed the long con- 
 tinuance of diarrhoea, without producing even weakness, much 
 less death 1 And who has not seen a profuse salivation, of even 
 months' continuance, during the agony of teething, without even 
 robbing the little sufferer's cheeks of their bloom ? Would this 
 obtain with the adult? No ! He would, perhaps, die by the first; 
 and certainly emaciate by the second. 
 
 We are well aware of the importance of the views now un- 
 der consideration ; we shall, therefore, advance nothing in sup- 
 port of them, that does not appear corroborated by our own ex-' 
 perience. For to us there are no positions in medicine more clear, 
 
PREFACE. V 
 
 than that there are few of the diseases of childhood which will 
 not yield to well directed evacuations ; and, that when not thus 
 treated, they become not only obstinate, but often formidable. 
 We are also equally persuaded, that could this view of the cha- 
 racter of the diseases of children gain the ascendency in the minds 
 of parents, much less difficulty would be experienced in the 
 treatment of them, and, consequently, few T er would be called to 
 an untimely grave. 
 
 It is w-ell known to almost every parent, that danger may 
 await the sudden stoppage of a diarrhoea, or incipient dysentery 
 by the use of astringents ; and many have had reason to remem- 
 ber, w T ith much sadness of heart, the improper drying up of the 
 discharge from excoriated ears, especially during dentition ; yet 
 in each of these instances, did we yield to the popular belief, 
 that nearly all the diseases of childhood are of the asthenic kind, 
 the early exhibition of laudanum, or some other astringent, would 
 be proper in the first, and some drying application necessary in 
 the second. 
 
 Besides, it has been but too generally believed that the disor- 
 ders of the internal organs of children have no distinctive signs, 
 by which we can determine, or fix, either the particular part at- 
 tacked, or the precise nature of the affection. From this we 
 must dissent ; for we are of opinion, that we can by a careful ex- 
 amination of symptoms determine the seat of the complaint ; and 
 by the particular state of the pulse, at least determine its gene- 
 ral character ; that is, whether it be a disease of too much, or 
 too little action; and this is the main point of investigation; for 
 it at once enables us to adapt the remedies to the general state 
 of the diathesis. For it must be recollected, that there is so 
 little difference in the general treatment of the inflammations of 
 the liver, lungs, stomach, bowels, windpipe, brain, &c, that little 
 or no embarrassment can be created, should any uncertainty 
 exist as to the particular viscera that may be affected. 
 
 And it must also be recollected, that every important viscus 
 of the body in a state of disease, has its corresponding marks 
 and sympathies, by which a careful observer may certainly de- 
 tect the organ to which it belongs. We grant that much expe- 
 rience, and careful observation are required to determine this ; as 
 well as to become familiar with the diseases of children, and to 
 prescribe for them with facility and certainty ; but this is attain- 
 
VI PREFACE. 
 
 able by well disciplined bed-side observation, and a correct 
 habit of thinking. 
 
 The belief that the diseases of children almost constantly pre- 
 sent nothing but perplexing obscurity or embarrassing uncer- 
 tainty, has much retarded the progress of inquiry, by engender- 
 ing doubts of their susceptibility of successful investigation, lu- 
 cid explanation, or useful arrangement, and of course, that every 
 prescribed remedy has but an uncertain aim ; and, consequently, 
 a contingent, or doubtful effect. We are far from entertaining 
 such opinions; and we are most anxious, so far as our feeble ef- 
 forts may have power, to banish them from the minds ; not only 
 of the medical practitioner, but from all who may entertain 
 them — for they are unworthy of the one, and painful to the 
 other. 
 
 The skepticism of which w r e are now speaking, has almost be- 
 come a popular belief; to the serious injury of the class of suffer- 
 ers about whom we are so deeply interested — it has made many 
 a parent resort to the prescriptions of an old woman, rather than 
 to the advice of the regular practitioner, from a persuasion, her 
 remedies are the safer because apparently the more simple ; thus 
 losing precious time or submitting to improper treatment. 
 
 Loss of time, is often of the greatest possible consequence ; 
 since it permits a disease of a dangerous character, to take an in- 
 sidious, and but too often, a fatal hold, before the danger is sus- 
 pected, or the proper remedy applied — this loss of time may 
 consist in a reliance upon an inefficient, or, perhaps, an improper 
 remedy, or in the total neglect of any remedy whatever. We 
 need only mention the overlooking of hoarseness in the early 
 stage of croup, or the neglect of the proper remedy in dysentery. 
 (See Chapter on Croup.) 
 
 How many parents have had reason to repent of the neglect 
 of a slight hoarseness, of perhaps even several days' continuance, 
 which terminated in a few hours after it had fully developed its 
 character, in death ; and how many, who, perhaps, in some mea- 
 sure aware of its tendency, had relied upon a feeble administra- 
 tion of antimonial wine, or a little of the expressed juice of the 
 onion, when nothing but the prompt application of active reme- 
 dies, could, even in its commencement, have subdued the dis- 
 ease. 
 
 We have divested our language of as much technicality as 
 
PREFACE. Vll 
 
 would be consistent with a work strictly medical: and we have 
 attempted to treat our subjects in as familiar a manner as we 
 are capable, without descending to a " Domestic Medicine." 
 We have also given a translation of our prescriptions, and added 
 a glossary of the medical terms ; that those who cannot procure 
 medical advice, may derive some advantage from them. But 
 let us be clearly understood to. discountenance, if not absolutely 
 to forbid, any interference with the province of the physician, 
 where his services can be commanded ; for we declare it, as our 
 4eliberate opinion, that much danger may arise from the neglect 
 of it. 
 
 " Ni Sutor ultra crepidam," 
 
 is an adage of much pith, as well as of great practical value. 
 
 35 
 

 
 J* 
 
 
THE DISEASES OF CHILDREN, 
 
 BOOK II. 
 
 H 
 
 GENERAL OBSERVATIONS. 
 
 "883. Children may be diseased, and even be near death, 
 while in utero ; but over such affections we have no control. It 
 is, therefore, no way surprising that we should find them occa^ 
 sionally emaciated, feeble, nearly, and sometimes quite exhaust- 
 ed at the moment of birth. The diseases of children then may, 
 with much propriety, be said to commence, even before birth; 
 though no remedy can be employed for their relief, until after 
 that event has taken place. 
 
 884. In treating, therefore, of the diseases of children, it is 
 proper to commence our account with the affections which may 
 declare themselves immediately after they are presented to the 
 world ; and these will consist in either the entire absence of res- 
 piration, or its imperfect establishment. 
 
 CHAPTER I. 
 OF THE ABSENCE OF RESPIRATION, &c. 
 
 885. We are of opinion, with Mr. White, Dr. Denman, Bau- 
 delocque, &c, that tying of the cord, prematurely, is very often, 
 if not always injurious to the child — therefore, it is laid down as 
 a rule, and which, we believe, can never with entire safety be 
 departed from, namely, that " the cord is not to be tied until 
 the pulsations in the umbilical arteries have ceased." Mr. 
 White, we believe, first drew the attention of accoucheurs to this 
 
276 OF THE ABSENCE OF RESPIRATION. 
 
 point ; and he has almost universally established an acquiescence 
 in the importance of the rule : so general has it become at pre- 
 sent, that if it were not recommended by any late writer, it 
 would be looked upon as an important omission. His opinion on 
 this subject, is founded upon the most correct physiological views ; 
 and he must be considered ag having contributed much to the 
 benefit of society, by the promulgation of a little essay " On the 
 Management of Children at the time of Birth." 
 
 886. In favour of the practice here recommended there is so 
 much concurrent testimony, that we have viewed with regret 
 the skepticism of Mr. Burns upon this point. He tells us,* that 
 " when the child is vigorous, and cries lustily, there is no occa- 
 sion of delaying, (the tying of the cord,) so long;" and adds, " nor 
 have I ever known any bad effects result from this practice." 
 And before, in his text, he declares, — " If it cry, or breathe vi- 
 gorously, then it may be safely separated from its mother." 
 These observations go certainly to call in question the propriety 
 or necessity of the rule, so well established by the experience 
 and reasoning of Mr. White, as well as almost every other prac- 
 titioner. 
 
 887. It is true that Mr. Burns almost in the same breath, de- 
 clares, "when the cord pulsates at the time of birth, we are never 
 to be rash in dividing it. It is of importance to keep up the foetal 
 circulation, till the new mode of acting can be established, and 
 we ought not to divide the cord completely in such cases, till 
 pulsation stop."f 
 
 888. Now, both of these directions cannot be right : on which 
 shall the young practitioner rely ? The propriety of Mr. White's 
 rule, we think, should never have been questioned — for until it be 
 proved an error, it is surely acting on the right side to adopt it ; 
 for it is not sufficient, to prove it one, that Mr. Burns declares, 
 he never knew any bad effect to result from the practice of ap- 
 plying the ligature while the arteries were yet pulsating. The 
 evils arising from the practice of applying the ligature too early 
 are not always so immediate, as to make us challenge it for their 
 cause; and the subsequent ones may be too remote, however 
 certain, to be considered as cause and effect. 
 
 889. The author of the little tract alluded to above, tells us, 
 and tells us we think truly, that " the pulsation of the arteries of 
 
 * Principles, Vol. II. p. 9, James's ed. t Ibid. Vol. II. p. 11. 
 
OF THE ABSENCE OF RESPIRATION. 277 
 
 the cord proves the existence of the foetal life.* The existence 
 of the foetal life proves the imperfection of the animal life. 
 While the animal life is imperfect, the foetal life ought not to be 
 destroyed. The navel string, therefore, should never be di- 
 vided or tied, where there is any pulsation in its arteries." 
 
 890. Mr. Burns denies the validity of this reasoning, by say- 
 ing, " It has been supposed, that as- long as pulsation continued, 
 the function of respiration was imperfect ; but it is not so ; the 
 pulsation depends more on the continuance of the vitality or ac- 
 tion of the placenta, than on the state of the lungs." This can- 
 not be : the pulsation of the arteries of the cord, must neces- 
 sarily depend upon those of the heart of the child. This is suffi- 
 ciently proved by observing the mode in which pulsation stops 
 in the cord. The cessation commences next to the placenta 
 itself, and gradually proceeds to the umbilicus of the child — this 
 is invariable : now, we would ask, what agency can the placenta 
 have in perpetuating the pulsations in the cord, since they are 
 always found first to cease next to this mass ? We grant the 
 agency of the placenta in maintahfing the foetal circulation — 
 but this ceases to be a complete operation, before the pulsations 
 in. the cord cease ; for these are maintained by the heart alone, 
 and they would continue this action, did we prevent the return 
 of blood to the child by opening the umbilical vein,- or putting 
 a ligature on it, until its sj^stem would be drained of almost 
 every drop.t But we must not be understood as maintaining, 
 that the pulsation of the cord depends upon the lungs — for we 
 know, that when they become perfectly pervious to the blood 
 by the new circulation being established, that they have a con- 
 trary effect — or rather, that the umbilical arteries must cease 
 to beat from a necessity imposed, by this new condition of the 
 lungs and circulation. We must, therefore, hold it important, 
 that the cord be not tied until the pulsation of its arteries ceases. 
 
 891. We have reason to believe we have seen several in- 
 stances of death, and this of a painful and protracted kinpl, from 
 the premature application of the ligature. And that this is pro- 
 bably one of the causes of the many deaths, in the hands of ig- 
 
 * The author calls the life of a child in utero, the foetal life; and the life con- 
 sequent upon respiration, animal life. 
 
 j- We suppose, in these cases, that the placenta preserves its attachment with 
 the uterus, and that the circulation is going 1 on, as before delivery. 
 
278 OF THE ABSENCE OF RESPIRATION. 
 
 norant midwives and practitioners, we have too much reason 
 to suppose. The constant practice of such pretenders is, to ap- 
 ply a ligature to the cord the instant the child is born ; and this 
 without regard to its pulsation, or state of the respiration. 
 
 892. Beyond all doubt, the first great object after the deli- 
 very of the child, is the establishment of its respiration : for the 
 most part, this takes place the instant it is in the world ; and, 
 indeed, it very often cries, and even forcibly, as soon as the 
 head is protruded through the external parts. But should it fail 
 to do this, every attention should be immediately paid that res- 
 piration.be established. Indeed, we have heard cries, though fee- 
 bly expressed, before the head has been delivered, and while the 
 face was lying on the perineum. 
 
 The child may be born in one of the following conditions: 1. 
 Feeble; but not exhausted, by either delay in its delivery, the 
 compression of the cord, or from a delicate stamina: these se- 
 veral conditions may be attended by a pulsating cord; or one 
 in which pulsation has ceased. 
 
 893. The cases in which the cord still pulsates, there is but lit- 
 tle risk, as long as this action continues ; and, for the most part, 
 all that is necessary, is, to remove all impediments from the 
 mouth which interrupt the passage of air to the lungs, and by 
 dashing upon its body some cold spirits or brandy: this almost 
 instantly makes it send forth cries. But should there be no pul- 
 sation in the cord, the child's body flaccid, and especially, if 
 upon dividing the funis only a drop or two of black blood issue 
 from the cut, the case is desperate, but not absolutely hopeless. 
 
 894. We should in this ca'se, 1st, carefully remove any mucus 
 that may be in the mouth, fauces, or trachea, by wiping them 
 carefully as far as we can reach with the little finger armed with 
 a piece of fine dry rag ; 2dly, by inflating the lungs, by holding 
 its nostrils, and applying our mouth to that of the child, and forci- 
 bly expanding its lungs, and then expelling the air from them by 
 a gentle, but pretty firm pressure upon the thorax ;* 3dly, by 
 
 * Mr. Burns recommends, " the cartilages of the trachea to be pressed gently- 
 back, to obstruct the oesophagus." (Vol. II. p. 11.) But this is never necessary if 
 the head of the child be made to rest upon the right hand, and thrown a little 
 backward; for in this position the skin on the fore part of the neck is put a little 
 upon the stretch, and made to press against these cartilages, and carries them 
 back sufficiently — the fingers of the left hand close the nostrils, while the mouth 
 of the operator is applied to that of the child. In this case, the feet of the child 
 should be towards the right hand. 
 
OF THE ABSENCE OF RESPIRATION. 279 
 
 placing the child's mouth downwards, and holding the body and 
 hips higher than the head, at the same time gently shaking the 
 child, that it may 'disengage any mucus that may be lodged in 
 the trachea, and permitting it to flow out of the mouth, by 
 making it the depending part — then cautiously wiping the mouth, 
 as just directed, renew the inflations and the suspensions alter- 
 nately, until the mucus is discharged from the mouth: by pro- 
 ceeding in this manner, we have often had the satisfaction of 
 seeing the child restored. It is a circumstance worthy of re- 
 mark, that, sometimes, owing to the tenacity of the fluid within 
 the windpipe, we cannot, at first, force air into the lungs ; but 
 by a little perseverance, we overcome this obstacle, and the 
 mucus sometimes becomes so thinned, as to flow readily from 
 the mouth, and at once relieve the child. This operation should 
 never be neglected; nor should it be too soon given up; espe- 
 cially if we can excite a few pulsations in the heart, or in the 
 cord: these parts should be carefully examined, after each in- 
 flation: the pulsation of the heart, when very feeble, is best de- 
 tected by placing the ear immediately over its region — that of 
 the cord, by pressing it between the thumb and finger, close to 
 the umbilicus. 4thly, By the application of dry warmth, by 
 means of heated cloths, frequently renewed: this precaution 
 should be immediately had recourse to, and should be perse- 
 vered in until the last moment. We much prefer dry warmth 
 as an application to the child's body, to the warm bath, which 
 is so much relied on in such cases — we think we have seen the 
 latter decidedly injurious, though we do not pretend to explain 
 the reason.* Might not a properly constructed syringe be high- 
 ly useful in removing the obstructing mucus. 
 
 895. When the child shows signs of returning life, it is gene- 
 rally by a deep short sob, which may be repeated at longer, or 
 shorter intervals; but, when we think the interval too long, we 
 should renew the inflations, &c. Should respiration be but im- 
 perfectly restored, we must carefully guard against fatiguing 
 the child; therefore it should not, on any consideration, be dis- 
 turbed by dressing it ; on the contrary, it should |be carefully 
 placed in such a situation, as to permit the frequent renewal of 
 
 * Does the warm bath invite too much blood to the capillaries of the surface, 
 and thus deprive the more general circulation of a portion, that may be essential 
 to the proper performance of this office? 
 
280 OF THE ABSENCE OF RESPIRATION. 
 
 warm applications, which are of primary consequence to it. We 
 have more than once had the mortification to find all our endea- 
 vours frustrated, by an inattention to our directions upon this 
 print, though given impressively. 
 
 896. 2. The child may be born healthy and strong, the funis 
 pulsating briskly, yet may not cry ; because a mechanical ob- 
 struction from mucus prevents the ingress of air into the lungs. 
 This mucus may be in the mouth or posterior fauces, or, it may 
 be in the trachea — if the first, we may entirely remove it by a 
 piece of fine rag upon the little finger, as just suggested ; (894) 
 if in the second, by suspending the child, as already directed, 
 which will seldom fail to give relief, by the mucus being dis- 
 charged by running from the mouth. We do not recollect an 
 instance, where it was necessary to have recourse to inflation, 
 while the pulsation of the cord continued ; but, when it stops be- 
 fore respiration is established, recourse must be had to it. When 
 the child has made attempts to cry, we may often succeed in 
 giving full force to it by dashing spirits or brandy upon its body. 
 
 897. 3. The child, from long delay in the passage, or having 
 its neck tightly begirt with the cord, may be born, still — in this 
 case, its face is livid, or even black, and swollen; the arteries 
 may have ceased to beat, or may beat pretty vigorously. In. 
 such cases, nothing can save the child from immediate death, but 
 instantly abstracting blood, by cutting the cord. Should the pul- 
 sation have ceased, we may sometimes still succeed in drawing 
 some blood, by forcing it from the cord with the fingers; and then 
 employing inflations, &c. If pulsation continue, we must abstract 
 blood by also cutting the cord. The quantity to be drawn must 
 be regulated pretty much by the effect. When respiration is 
 established, we need draw no more ; but until we see some signs 
 of this about to take place, we may abstract pretty freely, as 
 this process, most probably, is interrupted by the congestive state 
 of the brain, which can only be removed by ample depletion. 
 
 898. This practice of bleeding from the funis, in our hands, 
 has always answered a valuable purpose, in the congestive state 
 of the brain ; and to such cases it should always be confined. — 
 Baudelocque recommends this plan ; and we can bear witness, 
 in many cases, to its entire success ; for we have repeatedly seen 
 respiration established by this remedy, and by this alone. 
 
OF THE ABSENCE OF RESPIRATION. 281 
 
 899. Mr. White informs us, however, that he has " repeat- 
 edly tried this method, and the almost uniform consequence has 
 been the death of the child." We believe the cases which 
 proved unfortunate in the hands of Mr. W., to have been ill- 
 selected, or of so desperate a kind, that no remedy could have 
 saved them — for it does not follow, because the child has been 
 born still, after " a very hard and tedious labour," that it is a 
 case for depletion. And we have farther reason to believe his 
 unfortunate cases to have been ill-selected, by his confession that 
 bleeding did not always fail. The livid and swollen condition of 
 the face, must be present, to authorize the use of this remedy 
 — if they be not, we would not feel ourselves justified in ab- 
 stracting blood. Mr. Burns, with a view to get blood, recom- 
 mends cutting one of the umbilical arteries with a lancet or scis- 
 sors — but we believe, dividing the cord to be the better plan. 
 
 900. It will be always proper, before the cord is divided, to 
 pass a ligature loosely around it, that it may belied the moment 
 we have abstracted a sufficient quantity of blood. We should 
 be provided with a diaper, or a white cloth of any kind, to re- 
 ceive the blood as it flows from the divided vessels/that we may 
 have some means of determining the quantity abstracted. 
 
 901. When respiration has been but feebly, or imperfectly 
 performed, we think we have seen good derived from a few 
 drops of warm wine whey, if at hand, or wine and water. This 
 may be repeated every half hour, until it shall be no longer 
 necessary, either by the child breathing freely, or by its death. 
 
 902. Mr. Burns thinks, with Dr. Underwood, that, if electri- 
 city could be employed, it might be useful. Of this we can say 
 nothing from our experience ; yet it would seem to bid fair to 
 be beneficial, if time was sufficiently ample to apply it, or if 
 we had sufficient address to employ it. But unfortunately, a 
 single minute lost is enough to seal the fate of the child. The 
 case stated by Dr. Underwood, of the recovery of a child ap- 
 parently dead for two hours, by electricity, should awaken at- 
 tention to this subject. 
 
 903. We have rather dwelt upon this subject, because we feel 
 it to be one of much interest — for every one is not in possession 
 of the best method of treating still-born, or nearly exhausted 
 children, yet its importance will be obvious, upon a moment's 
 reflection. How often does the life /)f the child depend upon 
 
 3(5 
 
282 OF SYNCOPE, OR FAINTING. 
 
 the prompt application of the proper remedies ! Yet how few 
 out of the profession are qualified to give it, though the know- 
 ledge of what is proper upon such occasions is so easily attained ! 
 Every mother of a family should be acquainted with the proper 
 method of treating children upon such emergencies,* since she 
 may be so situated as to direct them, either in her own case, or 
 in that of a friend. 
 
 904. We will illustrate this, by relating a case which fell un- 
 der our notice in the year 1798. Mrs. — — was suddenly sur- 
 prised by labour in the middle of the night. Her husband was 
 despatched with all imaginable haste for us; while the lady was 
 attended to by her sister. The labour advanced so rapidly, that 
 the child was born before we arrived ; and when we handled it, it 
 was found to be perfectly dead. We, nevertheless, used all our 
 endeavours to restore it ; but they -were in vain. We found, upon 
 inquiry, that its death was altogether accidental; and its life 
 might have been saved, had its relation but suspended it by the 
 heels, and well cleared its mouth of the mucus which obstruct- 
 ed the passage of air to the lungs. 
 
 CHAPTER II. 
 OF SYNCOPE, OR FAINTING. 
 
 905. Under this head, we may class the condition of some 
 new-born children immediately after birth, as w r ell as the syn- 
 cope, properly so called, which sometimes supervenes several 
 days after this period. 
 
 906. In the first case, the child seems exhausted altogether of 
 muscular power; is pale, motionless, and flaccid ; it gives no other 
 evidence of life than feeble pulsation of the heart and the umbi- 
 lical arteries ; respiration is retarded, and perhaps, would never 
 be established, were the child left to itself. 
 
 907. This condition may arise from the imperfect development 
 of the child itself; though it may be considered as having tarried 
 within the uterus its full time ; or it may have been cast off pre- 
 maturelv. In both these cases the chance of recoverv is small: 
 
OF SYNCOPE, OR FAINTING. 283 
 
 since the want of development is a serious obstacle to recovery, 
 yet it is not altogether hopeless. 
 
 908. The first object to be attempted in such cases, is the 
 expansion of the lungs — this must be tried by dashing cold 
 brandy upon the body ; maintaining warmth, by means of heated 
 cloths; and preserving the funis entire, so long as pulsation 
 continues. If we succeed in producing respiration, the child 
 should be so placed, that it may derive advantage from the re- 
 peated application of dry heat ; it must be neither washed nor 
 dressed ; and its feeble powers must be' sustained by the most 
 unremitting application of warmth externally, and by the admi- 
 nistration of a few drops of wine and water, err wine whey,' 
 from time to time internally. If it cannot swallow, its lips and 
 nostrils may be every now and then moistened wrtrf a' little 
 wine, or brandy and water. 
 
 909. However unpromising appearances may be in the com- 
 mencement of this case, we are justified in saying, that we have 
 frequently been rewarded with success, by following the plan 
 just laid down; it, therefore, alw r ays deserves a trial. Should 
 this case be mistaken for one in which the brain is in a con- 
 gested state, and treated by blood-letting, it will surely prove 
 fatal ; and some of the instances, in which the author of the lit- 
 tle tract just named tried this remedy, and where the children 
 died, were probably of this description. 
 
 910. Children, who arrive at their full period, will, of course, 
 cceteris paribus, stand a better chance than those who are born 
 prematurely; but the latter should never be abandoned, because 
 the powers of life are feeble; especially if they have attained 
 their seventh month. We have witnessed two instances of 
 complete recovery, where, from all the data we could collect, 
 the children had but just exceeded the sixth month. These 
 were neither washed nor dressed for many days; but they were 
 preserved in a uniform temperature by means of a stove, and a 
 bed of cotton. A few drops of warm whey, from time to time, 
 was all the food they received for three weeks ; but on which 
 they throve surprisingly. 
 
 911. One of these children was carefully weighed when it had 
 attained its sixth week; its clothing, diaper, &c, and its little 
 self, weighed one pound and three quarters. The other was 
 not weighed, from a superstitious feeling upon the subject ; it 
 
284 OF SYNCOPE, OR FAINTING. 
 
 lived but three months— its death was occasioned by a catarrhal 
 fever, contracted from improper exposure. The former is 
 living at this moment, and is now a mother of two children. 
 She is still small. 
 
 912. There can be no question but the two children just men- 
 tioned were preserved, by not subjecting them to the fatigue of 
 washing and dressing. They were more than a month old, be- 
 fore they were exposed to these ordeals. 
 
 913. Children, who have undergone their full uterine deve- 
 lopment, and who would have possessed good stamina, had no 
 accident unfriendly to their lives accompanied the labour, may, 
 from the nature of such accidents, be' liable to this state of ex- 
 haustion. Thus, whatever diminishes the proper quantity of 
 blood circulating in their systems, will produce this state of 
 weakness — as a separation of a portion of the placenta before 
 birth ; the placenta being too long, and too powerfully com- 
 pressed by the tonic contraction of the uterus itself; by the cord 
 being slightly compressed, when prolapsed, or when it inter- 
 poses itself between the pelvis and the presenting part, &c; 
 hence, the frequency of this state, when the causes just named 
 are known to exist. 
 
 914. These cases, if well managed, will very often terminate 
 favourably. All fatigue must be avoided, and all purgative 
 medicine be withheld. We have never ventured, under such 
 circumstances, to purge off the meconium, until the child ap- 
 peared to gain sufficient strength to bear the operation without 
 risk, even though this required a number of days ; for we be- 
 lieve that this substance may occasionally be serviceable in such 
 cases, by keeping up the stimulus of distention. We may at 
 least venture to declare, we have seen the child exhausted in a 
 few hours, when several, loose stools have followed each other 
 in quick succession. 
 
 • 915. A child so circumstanced, should not even be put to the 
 breast until its system has become more confirmed, by rest, and 
 judiciously administered nourishment. The milk of the mother 
 should be given it by the spoon, and this without removing the 
 child from its place of rest ; or, should the mother have no milk, 
 a little rennet whey may be substituted ; or, if something a lit- 
 tle more cordial be thought expedient, weak white wine whey 
 «nay be given. 
 
OF SYNCOPE, OR FAINTING. 285 
 
 916. It now and then happens, that a child may be rather 
 feeble when first born, but recover its powers by proper atten- 
 tion, and every thing giving promise of doing w r ell — when it 
 suddenly becomes pale, flaccid, cold, with a long interval be- 
 tween each breathing, and at last respiration appears to stop; 
 the fingers and hands become blue, or black; the lips livid, and 
 the eyes fixed, and but half closed; the pulse extinct — in a 
 word, looking " the image of death." After remaining in this 
 condition for a short time, a slight convulsive motion will ap- 
 pear to play about the mouth, an imperfect inspiration will be 
 taken, followed by an expiration, attended by a peculiar noise ; 
 the lips become less livid ; as do the hands and nails ; the eyes 
 move languidly, and the pulse may now, by close attention, be 
 perceived, like a vibrating thread, at the wrist ; an attempt to 
 cry is made, but the sound is so feeble, that it can be heard only 
 at a very short distance — and this finishes the paroxysm. 
 
 917. After the " fit," as it is called, has terminated, the child 
 will appear languid, and uneasy, for sometime; it will generally 
 swallow if any fluid be presented to it, provided it be not too 
 soon after the paroxysm. A discharge from the bowels almost 
 always takes place during the " fit," of a small quantity of a very 
 green fluid. These spells are repeated at longer or shorter in- 
 tervals, unless the disease be arrested by the influence of reme- 
 dies, or death close the scene. 
 
 918. A case of this kind occurred to us, which we will pro- 
 ceed to relate ; and the mode of treatment will at the same time 
 be made known. 
 
 919. Mrs. F. was delivered, on the 13th of March, 1825, of a 
 small, but apparently healthy child ; she supposed she had not 
 arrived, by two weeks, at her full period. The child cried dis- 
 tinctly, but not very forcibly. It was at the usual time washed 
 and dressed, and took without difficulty a little warm molasses 
 and water. The next day, it appeared to be doing very well; 
 its bowels were opened freely, and it sucked when put to the 
 breast. It continued to do as well as children in general, for se- 
 veral days, (until the tenth,) when it seemed more languid than 
 usual, and did not take its nourishment so freely, nor draw so 
 firmly at the breast ; but as it had had several watery green stools 
 during the night, its languor was attributed to this cause. The 
 condition of the bowels was but little regarded; as the nurse sup- 
 
286 OF SYNCOPE OR FAINTING. 
 
 posed the discharges were not so frequent, as to require any 
 medicine. In this situation things remained until the following 
 day, when the child, after having repeatedly during the morn- 
 ing refused nourishment, " fainted," as the nurse called it, and 
 I was immediately sent for. 
 
 920. When I arrived, the child was in a state of faint, or syn- 
 cope — so completely, however, did it resemble one dead, that I 
 thought it was actually so, and expressed a fear to that effect. 
 The nurse said, No — it was not dead ; it had only fainted, as it 
 had done several times before. I placed my ear over the region 
 of the heart, but could hear no pulsation. 
 
 921. I caused flannels to be wrung out of quite warm whisky, 
 and applied all over its little body; small sinapisms were placed 
 upon the temples ; a drop of brandy was insinuated into its mouth, 
 and its nostrils were wetted with a little sharp vinegar. After 
 these applications were* made, which must certainly, I think, have 
 occupied five minutes, the little creature began to discover signs 
 of returning animation ; contrary, I confess, to my calculation. 
 The return, as it were, to life, was pretty much in the order 
 stated above ; the child, however, was found very much exhaust- 
 ed, and it was some time before it could swallow. 
 
 922. The bowel complaint was now increased greatly, and the 
 poor child nearly exhausted. It had no return of syncope while 
 I staid, which was about an hour; yet it could hardly be said to 
 be alive. I directed the whisky stoups to be continued; and a 
 Weak chalk mixture with a little laudanum, was ordered to be 
 given every hour, or until the condition of the bowels should be 
 improved. A little wine whey, with an equal quantity of cin- 
 namon tea, were directed to be given as often as the child could 
 swallow them. 
 
 923. I repeated my visit in the evening. The child had had 
 during my absence one "fainting fit," but it did not last so long 
 as the former; its bowels were still much disturbed, and the 
 child looked more like a corpse than a living being. I desired 
 all the previous remedies to be punctually continued. My next 
 visit was not until early the next morning. The child had had 
 several slight " faintings ;" its general appearance I thought 
 more favourable ; it swallowed with considerable freedom ; its 
 bowels were much improved ; it could cry audibly, and looked 
 about with some vivacity. During the whole of this period, its 
 
OF THE MECONIUM. 287 
 
 little eyes swam in a yellowish fluid, of considerable tenacity 
 and quantity — indeed, the quantity was so great, as to flow 
 down its cheeks ; and so tenacious, as to be traced through its 
 whole course, by the coat which it left upon the skin. 
 
 924. I desired a perseverance in the plan mentioned. From 
 this time, it began to recover, and mended rapidly, without any 
 return of the faintings. It is now alive, and doing well. 
 
 925. Dr. Underwood recommends, upon similar occasions, a 
 more stimulating plan, upon the authority of Mr. Hey, of Leeds; 
 such as the volatile tincture of Valerian ; and upon his own, the 
 fumes of lighted tobacco forced into the child's mouth. I can 
 say nothing as regards the efficacy of either of these plans, from 
 any trials of my own. It certainly comes recommended by high 
 authority, and should, therefore, be deserving of confidence. I, 
 however, confess, that I entertain some apprehensions of the 
 tobacco fumes, from its known narcotic powers — but I will not 
 oppose speculation to experience. During the severe part of 
 the above child's illness, I did not permit it to be dressed— on 
 the contrary, it was kept naked, for^the better employment of 
 the warm whiskv. 
 
 CHAPTER III. 
 
 OF THE MECONIUM. 
 
 926. We have, in the first part of this work, (Book I. p. 153,) 
 already spoken of the substance called meconium, and of the 
 propriety, or necessity of purging it off. We shall not repeat 
 what we have already said upon this subject ; but we may add 
 what we did not urge at that time. Since writing what is here 
 referred to, a case has occurred, which most decidedly proves 
 the necessity, if farther argument were wanting, of carefully 
 and completely carrying off this offensive recrement. 
 
 927. A child born healthy, had its bowels liberally purged, 
 as it was supposed, by the ordinary remedies. It remained 
 perfectlv well for several days, and had taken the breast freelv. 
 
288 OF THE MECONIUM. 
 
 At about the eighth day, the eyes and skin appeared rather yel- 
 low, though its' urine was not altered in colour. Its bowels 
 were a little affected, and had frequent, but very sparing watery 
 stools ; it hiccoughed often ; its skin was dry and hot ; it became 
 very restless, and refused the breast, though evidently very 
 thirsty, as it would receive with greediness, water, or any other 
 thin fluid, from a spoon. It would often start, and at such times 
 would move its limbs violently for half a minute together. Its 
 tongue was very white, and loaded with a substance resembling 
 a stratum of coagulated milk. It did not vomit, though evident- 
 ly distressed at stomach, as it would frequently gag, but could 
 get nothing up. 
 
 928. Believing its distress to arise from some irritating cause 
 in the first passage, we ordered a tea-spoonful of warmed castor 
 oil ; and this to be repeated in two hours, if the first did not suc- 
 ceed. A second, and a third, were given, without moving the 
 bowels. Magnesia, in five grain doses, followed by a tea-spoon- 
 ful or two of lemonade, were then given. It took a scruple of 
 this medicine, with no better effect. Its stomach now began to 
 revolt at every thing that could be offered it ; and the purgative 
 medicines were in consequence suspended. The abdomen be- 
 gan to swell, and became very tense and shining. It could lie 
 but on its back, with its little legs drawn close up to the belly, 
 and was evidently in a state of great suffering. Its cries were 
 piteous and incessant ; and its whole skin became bedewed with 
 a cold sweat. 
 
 929. Injections of various kinds were thrown up the rectum ; 
 the child was placed in the warm bath ; but no stools were pro- 
 cured, for the little tinged mucus which came away every now 
 and then, by severe straining, did not amount to a stool. We 
 had upon several late occasions with children, found a solution 
 of the carbonate of soda, very useful in aiding the operation of 
 medicine, in cases of constipation; we, accordingly, determined 
 to administer a grain of this article in a tea-spoonful of luke- 
 warm water, every fifteen minutes, until ten grains should be 
 taken. 
 
 930. At the expiration of two hours and a half, the bowels 
 began to move ; and in the course of three or four hours, there 
 were ten evacuations, each of which evidently contained a quan- 
 tity of the meconium, with the exception of the first two.- The 
 
OF JAUNDICE. 289 
 
 purging was now kept up by an additional tea-spoonful of cas- 
 tor oil, and was permitted to go on, until the meconium was no 
 longer visible in the evacuations. Dr. Underwood gives a si- 
 milar history; but one in which a much larger quantity of me- 
 dicine was exhibited. 
 
 931. We have related this case with several views :— 1st, to 
 prove the necessity of purging off the meconium ; 2dly, to show 
 that this substance, when not completely carried off, will most 
 probably create a good deal of distress, or even severe disease ; 
 3dly, that though the meconium may disappear from the early 
 evacuations of the child, it is no proof that there is none re- 
 maining ; 4thly, that while it has possession of the bowels, it 
 prevents, by its tenacity, the usual action of purgative medi- 
 cines ; 5thly, that by the exhibition of the soda, some change 
 was effected in the bowels, favourable to the operation of the 
 remedies previously exhibited. 
 
 CHAPTER IV, 
 OF JAUNDICE. 
 
 932. The skins of newly born children are frequently of a yel- 
 low colour ; but this does not constitute the disease in question. 
 The yellowness here spoken of, is not of a deep tone, though 
 very generally diffused. This appearance may continue for se- 
 veral days, and then disappear without the aid of remedy, or 
 without leaving any evil behind. It is difficult to say to what this 
 yellow tinge may be owing : certain it is, it is not attributable 
 to the presence of bile; since neither the urine, nor the whites 
 of the eyes, assume the yellow hue. 
 
 933. We know that changes from a white to a yellow skin 
 take place upon certain occasions, and this sometimes with sur- 
 prising rapidity, by some occult change in the cellular mem- 
 brane or rete mucosum, without our being able to declare the 
 cause. This is remarkably the case in yellow fever ; where the 
 presence of bile cannot be detected in the circulating fluids. 
 The same thing takes place with certain people, from strong 
 
 37 
 
290 OF JAUNDICE. 
 
 affections of the mind, peculiar derangement of the stomach, or 
 from the bite of certain reptiles, without the aid of bile : it also' 
 occurs, occasionally, with the new-born child. 
 
 934. Therefore, every yellowness of skin must not be mis- 
 taken for jaundice, as it would lead to great errors in practice. 
 Our attention is frequently drawn to this appearance by nurses; 
 and when it is observed, we make it a rule to investigate the 
 condition of the child, lest a real jaundice be present. 
 
 935. We direct our attention, 1st, to the whites of the eyes, 
 and the secretion of tears; if neither of these be tinged yellow, 
 we have reason to believe there is no jaundice ; but if they be, 
 we inquire, 2dly, into the appearances of the urine and faeces. 
 If the first be yellow, we suppose it a still stronger ground of be- 
 lief that there is jaundice ; and if the fseces be paler than they 
 should be, or of a clay colour, we are sure the child has a ge- 
 nuine jaundice. 
 
 936. We have, however, known all the marks or signs of 
 jaundice* to exist, (with the exception of the pale or clay-co- 
 loured stools,) without the child appearing to suffer in the least. 
 They have all disappeared spontaneously, or by the exhibition 
 of a single dose of castor oil, without being followed by the 
 slightest inconvenience. As long, then, as the stools are dark 
 green, or yellow, we need not give ourselves any anxiety about 
 the yellowness. 
 
 937. But if, on the contrary, the above marks be attended 
 by deficiency of colour in the stools; if the bowels be costive or 
 irritated to frequent efforts ; if the abdomen swell, and become 
 tense ; if the child be uneasy, fretful and inclined to vomit ; if 
 it really vomit a white glairy mucus; if it refuse the breast, and 
 frequently moan, as if in pain; if it hiccough, and emaciate ra- 
 pidly ; if its eyelids become glued together by a yellow tena- 
 cious serum, jaundice, in its most formidable form, is present. 
 
 938. In cases of this kind, the liver itself has sometimes been 
 found much diseased, as in the case related by Mr. Pearson, 
 (Underwood, p. 14 ;) in other instances, the common duct has 
 been obstructed, as in the jaundice of adults. 
 
 939. Dr. Underwood, (p. 13,) says, " I have found suckling 
 in that state, (with jaundice,) is capable of communicating the 
 true jaundice to a great degree, and that it will not be cured, but 
 by the recovery of the suckling mother or nurse, or the nurse 
 changed, or the infant being weaaed, as well as properly treat- 
 
OF JAUNDICE. 291 
 
 ed." We think the Doctor must labour under an error in this 
 statement. We have no difficulty in believing, that the serum of 
 the child's blood may become tinged with bile, since the milk it 
 sucks is coloured by it — consequently, the chyle also will be co- 
 loured; hence, some of the common marks of jaundice will be 
 present — that is, the whites of the eyes, the skin, and the urine, 
 will partake of the same general hue with the serum of the blood, 
 but the essential mark of jaundice, we are sure, will be want- 
 ing; namely, the light or clay-coloured stools, or the absence 
 of bile in them. It would be extremely difficult to conceive how 
 the tinged milk of the mother should either materially injure the 
 liver, or obstruct the common duct : and, unless one or the other 
 have happened, we believe a genuine jaundice cannot be pro- 
 duced.* 
 
 940. Nor is there any difficulty in accounting for the yellow 
 appearances of the child, or that it shall not get well, (that is, 
 lose its yellow appearances,) until the mother or nurse is cured, 
 and the child is weaned, since it is constantly receiving the same 
 coloured milk. 
 
 941. When a genuine jaundice attacks a new-born child, it is 
 but too often fatal, with whatever propriety or energy we may 
 attempt to relieve it. It is generally recommended to com- 
 mence the cure by an emetic: for this we have the authority of 
 Armstrong, Underwood; Burns, &c: to oppose our single ex- 
 perience against them, might appear ill-judged, if not rash. Yet 
 we dare not run counter to our own observations; especially as 
 we have given fair trials, (in our own estimation,) to the reme- 
 dy, and the result is decidedly against the practice. 
 
 942. Emetics have not only failed in our hands to remove the 
 disease, but have rendered the stomach so irritable, as not to 
 receive any other remedy willingly. We have, therefore, aban- 
 doned them for some years, and find we can succeed better by 
 another plan of treatment. 
 
 943. When we find symptoms of jaundice, that is, yellow skin, 
 eyes, and urine, we begin by giving small doses of castor oil; that 
 
 * The serum of the blood does not always become affected, even in true jaun- 
 dice. I have lately had a patient, who was suckling the whole time of the dis- 
 ease, yet there was not the least evidence of the milk becoming tinged with the 
 colouring matter of the bile, though I carefully examined it, from time to tima, 
 through the whole course of the complaint. Nor did the child in any one re- 
 spect appear to suffer. 
 
292 V OF JAUNDICE. 
 
 is, a small tea-spoonful every two hours, until it purges freely. 
 If, upon the inspection of the evacuations, we do not find bile in 
 them, we follow up the purging the next day, by giving calomel 
 in very small doses, until a cathartic effect be produced. This 
 may, and does require, sometimes, two or three days' perseve- 
 rance in the calomel, aided by small doses of soda, supersatu- 
 rated by carbonic acid gas, before the bowels are moved ; for 
 it must be recollected they are most commonly very torpid. 
 We have said we give calomel in very small doses ; the follow- 
 ing is our formula : — 
 
 R. Calom. ppt. gr. iij. 
 
 Sacch. alb. gr. vj. 
 
 M. bene, div. in xij. 
 
 944. One of these to be given every two hours, until they ope- 
 rate. They are best exhibited in a small drop of thin molasses, 
 washed down by the solution of soda, in the proportion of two 
 scruples to eight ounces of the carbonated water. 
 
 945. A tea-spoonful of the solution of soda may be given fre- 
 quently as a drink. Should the calomel, at any time after ex- 
 hibition, procure bilious evacuations, it should be desisted from, 
 or given less frequently. But, should it not, it must be perse- 
 vered in, unless the bowels become too much irritated ; in this 
 case, they must be appeased by laudanum, in quarter drop doses, 
 every two or three hours, until the effect be produced. During 
 this period, however, the solution of soda should be continued. 
 We have thought that advantage has been derived, by bathing 
 the abdomen with warm brandy, especially if this part be pre- 
 ternaturally hot or cold. In doing this, however, a caution 
 must be suggested that the parts be not unduly pressed, or rudely 
 handled, under the impression that this is essential to its efficacy. 
 
 946. Should diarrhoea, with bilious-looking or watery stools, 
 supervene, the calomel must be stopped, and laudanum must be 
 given, as directed above. During the whole of this time, the 
 child should receive its mother's milk as often as it well can, by 
 sucking, if able; or by the spoon, the milk having been previ- 
 ously milked out. 
 
 947. We have thought, also, that the occasional employment 
 of the warm bath has been useful, especially when there is a 
 disposition to spasm, or frequeat hiccough. 
 
 948. But, notwithstanding the employment of the above re- 
 
OF ERYSIPELAS. 293 
 
 medies, if the stools do not become bilious; if the tone of yellow 
 in the skin be increased, or rather looking black ; if the skin 
 become mottled ; the eyes blood shotten ; the urine very scanty, 
 and very high-coloured ; or if entirely suppressed ; the hands 
 and nails looking livid; if the child vomit, or be threatened with 
 convulsions, the case must be considered as extremely desperate, 
 though not absolutely fatal, as we once witnessed a case, where 
 all these symptoms were combined, yet the child recovered. 
 
 949. In the case just alluded to, we used, not knowing what 
 else to do, but almost solely with a view to relieve the anxiety 
 of the parents, a warm bath every two hours, for five minutes 
 at a time, in which an ounce of the sweet spirit of nitre was mixed. 
 After its first application, the child appeared revived; and each 
 subsequent one was followed by improvement — bilious evacua- 
 tions took place ; there was a liberal secretion of urine, and the 
 child mended from that moment with astonishing rapidity— we 
 do not, however, wish to attach much consequence to this first 
 trial — it was, perhaps, mere coincidence. It may, however, 
 deserve farther trial: — we have not ourselves had an opportu- 
 nity to repeat it since. 
 
 CHAPTER V. 
 
 OF ERYSIPELAS. 
 
 950. Children in the month are sometimes liable to inflamma- 
 tion of the skin of the erysipelatous kino 1 , which locates itself 
 variously. It is not, however, a very common affection, espe- 
 cially among the higher classes of- society. It is a disease of 
 more frequent occurrence, it would seem, in Europe, and espe- 
 cially in the lying-in hospitals, than in this country. 
 
 951. When this complaint is a symptom of some prevailing 
 endemic of crowded hospitals, it is considered by both the French 
 and English writers, as one of great danger. Dr. Underwood 
 says he has not met with this disease often, except in lying-in 
 hospitals. Its ordinary time of attack, is a few days after birth; 
 and was thought, by some, never to appear later than the month 
 — but he says this is not the case ; and this agrees with our own 
 observations. 
 
 952. We have seen this certainly later than the third month; 
 and in one instance, and that one of a most ferocious kind, the 
 
294 OF ERYSIPELAS. 
 
 child was beyond the sixth month. It would seem that no part 
 of the body is exempt from an attack of this inflammation; at 
 least, we have seen it commence upon various portions of it. 
 In the instance just alluded to, it might be said to have had no 
 "local habitation;" for we saw it occupy a leg, a thigh, an arm, 
 the face, or the body, in the course of twenty-four hours. 
 
 953. Its translations were rapid, beyond belief; and the part 
 occupied at one moment would, in another, be left free from dis- 
 ease; while a new portion of the body, uncertain which, would 
 be obliged to sustain its attack; in its turn, in the course of two 
 or three hours, might be left with equal capriciousness to fix 
 upon some new part, without the one just left having received 
 any material injury. The inflammation, in this instance, did 
 not vesicate until it had fixed permanently upon the head and 
 face; which it did, after having pursued this erratic course for 
 five days. After the head and face became affected, the disease 
 seemed to forget its fugitive course, but not its deadly charac- 
 ter. The face and Head became immensely swollen; the sur- 
 face attacked became purple, and vesicated over its whole ex- 
 tent ; delirium followed, and death soon closed the scene. 
 
 954. The places most commonly selected for this inflamma- 
 tion, agreeably to our experience, are the nates, the neck, the 
 small of the back, # and face. It usually begins by a spot of un- 
 certain size, and ill-defined extent. Fever is almost sure to at- 
 tend;! an d the child to betray great marks of suffering. The 
 extent of the inflammation may be very limited for several hours, 
 or even days, unless it vesicate early: when this happens, the 
 disease spreads with much greater rapidity, and the child sud- 
 denly becomes dangerous. The stages of this inflammation are 
 sometimes passed witn* great rapidity; a bloody ill-looking pus, 
 or ichor, is quickly formed, which very soon extends itself 
 through the meshes of the cellular membrane, to an undefined 
 distance. 
 
 * I have had a case lately in which this affection, the third day after delivery, 
 attacked the whole of the upper portion of the back — that is, from the occipital 
 bone, to a little below the points of the scapula. There was much hardness, red- 
 ness, and swelling of this part — it was relieved by the mercurial ointment alto- 
 gether? no other application having been made. It required four weeks to con- 
 firm the cure. 
 
 f It seems very certain that this disease is both idiopathic, and symptomatic — 
 therefore, fever may follow the appearance of this inflammation, or this inflam- 
 mation may be subservient to fever. 
 
OF ERYSIPELAS. 295 
 
 955. Whenever this inflammation extends to the cellular tis- 
 sue, it is sure to destroy it, by forcing it to a rapid suppuration, 
 and thus divesting theparts of this important membrane. Ab- 
 scesses, or rather collections of matter, are, therefore, formed of 
 unequal size, throughout its course; and when the subjacent 
 parts are exposed by the removal of the skin which before co- 
 vered them, the muscles are as completely denuded of all their 
 cellular covering, as if they had been most carefully dissected. 
 
 956. Should the part attacked in this way be a depending one, 
 the ill-formed pus, or sanies, insinuates itself to an uncertain ex- 
 tent ; for, it has no bounds set to its ravages, by a protecting ef- 
 fusion of coagulable lymph, as in a genuine phlegmonic inflam- 
 mation. Hence, we once saw it run from the lower point of 
 the left scapula, to the base of the sacrum. 
 
 957. Notwithstanding the apparent irregularity of this species 
 of inflammation, it has four distinct stages: 1st, inflammation 
 without vesications; 2dly, with vesications ; 3dly, with vesications 
 and suppuration : 4thly, gangrene. There is something very 
 peculiar, if not sui generis, in this inflammation ; and on this pe- 
 culiarity does its danger very much depend ; but our limits do 
 not permit us to describe them but in very general terms. 1. 
 Its erratic disposition — as it may in an instant almost leave the 
 part it occupied to seize upon another, however remote or im- 
 portant that part may be. 2. Its disposition to vesicate. 3. 
 The rapidity with which it runs on to its own peculiar suppura- 
 tion ; for it is without any provision, by the effusion of coagu- 
 lating lymph, to limit its extent. 4. To its strong tendency to 
 gangrene, seeming at once to kill the skin and cellular mem- 
 brane, by the force of its previous inflammation. 
 
 958. Much difficulty has ever been experienced in the manage- 
 ment of this disease, especially in children, with whom its pro- 
 gress is almost always more rapid and subduing than with adults ; 
 and not less diversity of opinion than difficulty has existed, as to 
 the proper plan to be pursued. In almost every part of Europe,, 
 this disease is considered one of great danger ; and, in this coun- 
 try, it has had but too many victims. Whether this disease be 
 necessarily one of so much danger, is much to be doubted ; un- 
 less difference of climate has more influence than the mode of 
 treatment ; for it has certainly, within the last few years, been 
 
296 OF ERYSIPELAS. 
 
 less fatal than formerly ; and this melioration, we believe, is 
 justly attributable to the plan of cure. . 
 
 959. Dr. Underwood thinks the bark the best constitutional 
 remedy ; and saturnine and camphorated applications to be the 
 best local remedies. Mr. Burns approves of cold watery appli- 
 cations, where the heat of the part is considerable ; but .thinks, 
 with Dr. Gartshore, that the camphorated spirit of wine is the 
 best application from first to last. He seems doubtful as to the 
 efficacy of the bark ; but recommends from five to ten grains of 
 ammonia,* every three hours — but says, he has derived more 
 benefit from calomel purges than from any other medicine. 
 
 960. We shall say a few words upon each of these plans, be- 
 fore we detail the one usually pursued by ourselves, and other 
 practitioners in this city. 1. As the system evidently labours 
 under high arterial action in the commencement of almost every 
 case of erysipelas that requires medical treatment, the bark must 
 not be thought of, either in the first or second stages of this dis- 
 ease : in either of the two last, it may often be proper, if the 
 suppuration, or sloughing be extensive. 2. As regards the to- 
 pical applications recommended by these gentlemen, the cold 
 saturnine have always appeared to us, if not of hurtful tendency, 
 at least of doubtful efficacy. In the early, or first stage of ery- 
 sipelas, the camphorated spirit we have thought occasionally 
 useful, but never efficacious. 3. The propriety of using am- 
 monia in such immense doses to a child, perhaps, within a 
 month old, is extremely doubtful, even if it were possible to give 
 it, (which, by the by, in our opinion, is extremely problemati- 
 cal ;) but its usefulness in any quantity may be justly doubted, 
 especially as the disease, in its commencement, at least, ac- 
 cording to Mr. Burns himself, is attended with fever. Of the 
 good effects of calomel purges, we entertain no doubt ; but must 
 say purging with it, or any other cathartic medicine, seems to 
 be much at variance with bark and volatile alkali. 
 
 961. It is probable, that erysipelas may have a number of 
 counter-agents ; but there are very few, we believe, yet ascer- 
 tained. In the time of Ambrose Pare, blisters were employed 
 to interrupt the progress of this inflammation, both as regards 
 
 * We take it for granted, that Mr. Burns means the carbonate of ammonia", by 
 the simple word ammonia. 
 
OF ERYSIPEH>. 297 
 
 the extent of surface over which it might be supposed to travel.. 
 as well as the terminations of two of its stages in either suppura- 
 tion or gangrene. This remedy, however, was either forgotten 
 or laid aside, for nearly two centuries, because the modus ope- 
 randi of the application could not be explained. To the late 
 Dr. Physick we owe its revival, the importance of which can 
 only be appreciated by those who have witnessed the almost 
 wonder-working operation of this agent. We have frequently 
 succeeded with it, both in the adult and in the child; and can 
 most safely recommend its application, when the inflammation 
 attacks such parts as can readily be covered with a blister. 
 
 962. The plaster should be of such a size as will rest with 
 certainty upon the sound skin — if this precaution be not taken, 
 its application will avail but little. When the sound skin is well 
 vesicated, the plaster is to be removed, and the part to be treated 
 as if a blister had been used for any other purpose. 
 
 963. It, however, frequently happens, that a blister will be in- 
 expedient, from the peculiar location of the disease ; in such case, 
 we use the strong mercurial ointment, (without turpentine,) by 
 covering the inflamed, as well as the sound skin, with a coat of 
 it; and when it is removed, or becomes dry, it is renewed by a 
 fresh application. We use this ointment differently, however, 
 in the several stages of this inflammation ; we shall, therefore, 
 describe our method ; and, 
 
 964. 1. Where the part is inflamed, but not yet vesicated. 
 When we see the inflammation in this stage, we cause the whole 
 of the reddened part, as well as a portion of the sound skin, to 
 be covered with the ointment ; which is to be renewed, when 
 the part is deprived of any portion of it. 
 
 965. 2. Where the part is vesicated, but the vesicles not 
 opened. In this case, we cause the vesicles to be carefully 
 opened, and the ointment applied as just directed for the first 
 condition. 
 
 966. 3. Where the vesicles have opened spontaneously, and 
 the part has become incrusted, and the inflammation spread to 
 a considerable, or to a more limited extent. In this case, we 
 direct the ointment to be applied only to the surrounding in- 
 flamed margin, and on a portion of the sound skin. 
 
 967. 4. Where portions have proceeded to suppurate, yet a 
 part of the surrounding skin is inflamed. Under such circum- 
 
 38 
 
298 OF ERYSIPELAS. 
 
 stances, we open the collections of matter as early as possible ; 
 and apply the ointment to the margin, as above directed. (966.) 
 
 968. Such is the efficacy of the mercurial application, that it 
 almost immediately arrests the farther progress of the disease; 
 therefore, when practicable, it should be had recourse to early. 
 
 969. We know but one objection to this powerful counter- 
 agent— the patient sometimes becomes salivated. This, however, 
 seldom or never happens with young children, who are most ob- 
 noxious to the disease for which it is prescribed. In adults, on 
 this account, we sometimes prefer the blister.* 
 
 970. We have already noticed, that the suppuration in the 
 erysipelatous inflammation, is not of a genuine pus ; it is always 
 more or less bloody, and generally very offensive — this may also 
 be said, when the part becomes gangrenous. The charcoal 
 poultice, in such cases, is of great value ; or the diluted pyro- 
 ligneous acid maybe most advantageously used; or a poultice 
 made of a strong decoction of bark, or even of its substance. 
 
 971. Hitherto, we have dwelt upon the external treatment of 
 erysipelas ; we shall now speak of the internal remedies which 
 we have found best suited to this disease. 
 
 972. In the early stages of this affection, when accompanied 
 by constitutional symptoms, as fever, headach, delirium, &c, 
 the patient should be confined exclusively to the mother's milk, 
 and that given but seldom. The bowels should be kept freely 
 open, but hot severely purged, by small, but repeated doses of 
 calomel. Should fever run high, with strongly marked cerebral 
 affection, the child should lose blood from the arm ; or from the 
 temples, Toy leeches. 
 
 * It would seem, that the origin of the mercurial treatment is peculiar to this 
 country; and the honour of the discovery Is claimed by Drs. Little and Dean. 
 Their claims are urged with such equality, that there would be a risk of doing 
 injustice to one, by admitting' the claims of the other. 
 
 It appears, that this is not the only mercurial preparation that has been useful 
 in this complaint. A solution of the corrosive sublimate, in the proportion of one 
 grain to the ounce of water, Dr. Schott of this city informs us, has been found 
 equally efficacious. And it may be justly questioned, whether this practice may 
 not be of old date, but, like many other substances, have fallen into disuse, from 
 occasional failures; certain it is, we saw it used very extensively about the year 
 1785 or 6, in an erysipelatous condition of the leg from phlegmasia dolens. The 
 precise effect of this application is not at this time recollected, as it was supposed 
 at the time by me to be a part of the routine of practice in such cases. 
 
OF ERYSIPELAS. 299 
 
 973. Fresh, cool air, should be freely admitted to the body of 
 the patient ; and the room should always be well ventilated. 
 Among many people there is a prejudice against this plan; 
 they are fearful of adopting it, lest the inflammation " strike 
 in." But of this, they should be assured there is no danger; 
 and the plan must be insisted on. 
 
 974. When this inflammation runs on to suppuration, or ter- 
 minates in gangrene, the system will become enfeebled, either 
 by the extent of the discharge, or the peculiar character of the 
 disease; especially when it has a tendency to become epidemic. 
 Here, we are persuaded, the bark, in some form or other, be- 
 comes absolutely necessary; and as far as one case will justify 
 the recommendation, in the form of a sulphate, is the most easy 
 of exhibition, and is as efficacious as in substance or in decoc- 
 tion. The bowels at this time are very apt to become too loose 
 — this must not be permitted to go on, or the little sufferer will 
 speedily sink. 
 
 975. To arrest the too free motion of the bowels, the chalk 
 mixture, with minute doses of laudanum, should be given, in the 
 form following: — 
 
 . Cretappt 
 
 33- 
 
 Tinct. Thebaic. 
 
 gut. X. 
 
 Ol.Carui. 
 
 g«t. i- 
 
 Sacch. alb. 
 
 3li- 
 
 Aq. font. 
 
 ±iss. M. 
 
 Of this a child of ten days old may take half a tea-spoonful 
 every two hours, until better ; one of a month, to that of two 
 months a tea-spoonful, as often, until the bowels are checked. 
 Should it appear to be in pain, an additional quantity of lauda- 
 num must be given ; say, from one to two drops. 
 
 97G. The child may now be indulged with the breast, to the 
 extent of its appetite; and its little strength must be husbanded 
 with every possible care. It may, with this view, from time to 
 time, take two or three tea-spoonsful of wine whey, carefully 
 made, and not of too great strength. • 
 
 977. The whey should be made as follows: take half a pint 
 of new milk, and bring it to the boiling point, in an earthen or 
 silver vessel— at that moment throw into it a common-sized 
 wine-glassful of Madeira, Sherry, or good Teneriffe wine— stir 
 it two or three times round, and then set it in a cool place to se- 
 
300 OF THE RETENTION OF URINE. 
 
 parate. When separated, pour off the whey from the curd, 
 and sweeten it to the taste with loaf sugar. 
 
 978. Of that form of erysipelas, which attacks the genital 
 parts of new-born children, we have seen but one instance ; and 
 this, not until nearly the whole of the parts were destroyed, and 
 when art could do nothing for its relief. 
 
 CHAPTER VI. 
 
 OF THE RETENTION OF URINE. 
 
 979. It very frequently happens with newly born children, 
 that they do not pass their urine for many hours after birth, or 
 so sparingly, as to afford little or no relief; this creates a great 
 deal of distress, and if not relieved by proper means, will some- 
 times occasion death. A very remarkable instance of this kind 
 fell under the notice of my friend Dr. Parrish, and myself, 
 • which given in detail, we trust, will require no apology. Mrs. 
 
 was delivered of a healthy child, on the 15th of June, 
 
 1822. On. the 20th, in the evening, the child showed uneasi- 
 ness; and on the 21st, it cried violently, and continued to be 
 much pained until the 25th. A variety of simple remedies 
 were used for the relief of the urine, which had been either 
 very sparingly passed or entirely suppressed, most probably from 
 the 20th— but without relief. On the morning of the 25th, at 
 ten o'clock, we found the abdomen very much distended, even 
 to the scrobiculus cordis; the skin was shining, and the super- 
 ficial veins were very much enlarged. The child had several 
 very sparing stools of a dark green colour : two spoonsful of 
 castor oil were given in the course of the morning. At half 
 past one o'clock, P. M., Dr. Parrish introduced a small flexible 
 catheter, and drew off at one time eighteen ounces and a half of 
 a straw-coloured urine.* ' At seven o'clock the same day, the 
 
 * "The introduction of the catheter, spoken of in the case of a child of ten 
 days old. We have never had occasion to employ the instrument at so early an 
 age, and fear that its employment is more easily described on paper than carried 
 
OF THE RETENTION OF URINE. 301 
 
 child appeared perfectly relieved; it slept soundly, and took 
 nourishment freely. Two more tea-spoonsful of castor oil had 
 been given since the visit at noon, but without moving the 
 bowels ; nor did any water pass. As the child was easy, it 
 was permitted to rest without disturbance. 
 
 980. From this time, the water was regularly drawn off by 
 the catheter until the child's death, which happened on the 28th. 
 It had gradually declined from the time of our first visit, and its 
 mouth had become very sore. Permission was not obtained to 
 examine it. 
 
 981. We have recorded this case on account of its great prac- 
 tical importance, though unfortunate in its issue. We have seen 
 several instances similar in their general appearances to the one 
 just related, and, like it, ending in death : we have strong rea- 
 son to believe they may have died of retention of urine, though 
 we were assured that they had passed water — the same was 
 insisted on, for awhile, in the case just mentioned, and, perhaps, 
 there may have been a small discharge, as always happens 
 when the bladder becomes excessively distended. We know 
 that this often takes place in the adult, from the same cause. 
 We ever make it a rule to inquire into the state of the blad- 
 der, in all . the little complaints of very young children ; but 
 we fear we have been too easily satisfied with the reports of 
 the nurse upon this subject — we now make it our business, 
 whenever we have any suspicion that the urine is not freely 
 evacuated, to examine the abdomen of the child, especially if 
 it be reported as swelled— we carefully examine the region of 
 the bladder, with a view, to detect any distention of it, if it 
 exist, that we may take our measures accordingly. We are 
 sincerely of opinion, that, had the catheter been introduced 
 twenty-four hours sooner, nay, perhaps twelve, the poor infant, 
 whose case is related above, might in all probability have been 
 
 into execution in practice, particularly in the male." — Lond. Med. and Phys^ 
 Journ. August, p. 149. 
 
 In a case similar to the one which gave rise to the above observation, it may be 
 asked, what other resource does our art afford? I have not declared, nor even 
 insinuated, that the catheter should be used upon slight occasions; but where the 
 retention is confirmed, and where every usual expedient was resorted to, and had 
 failed, should we suffer the patient to die, because the introduction of a catheter 
 is considered difficult? I can truly say, in the above case, the gentleman who 
 
 performed the operation, found no difficulty whatever. 
 
 In relating the above case, I have confined myself to the detail of the main 
 
 facts; I have not attempted to describe the mode of introducing the catheter. 
 
302 
 
 OF APHTHA. 
 
 saved; but, as there was a constant assurance that water 
 passed, no suspicion was entertained of the state of the bladder, 
 until all the mischief was done, that could well happen from its 
 fulness. We always inquire into the state of the bladder, and 
 did so particularly in this case, and were constantly assured by 
 the nurse, that water had been freely passed. 
 
 982. We suggest, as a matter of probability, that the cases 
 we have witnessed of death in very young children, where the 
 abdomen has been much swollen, and the superficial veins pass- 
 ing over it much distended, and very conspicuous, were similar 
 affections of the bladder, though no such suspicion was enter- 
 tained at the time. How far a distended belly, (indeed, almost 
 to transparency,) with greatly enlarged veins, may serve to 
 distinguish this state of the urinary organs in very young chil- 
 dren, must be left to future observation. We have felt it a 
 duty to express this impression, with a hope that it may awaken 
 attention in those whose province it is to witness numerous 
 cases of sickness, especially in very young children. The case 
 just related is an extreme one ; many occur where the retention 
 is not so_ absolute, yet it is every way important to offer some 
 relief to the bladder, For the most part, these slight retentions 
 are easily removed, by a few drops of the sweet spirit of nitre, 
 once an hour, in a little sweetened water; or, if obstinate, it may 
 be aided by the warm bath, and a tea-spoonful of castor oil. 
 A little parsley root tea, also, succeeds remarkably well. 
 
 CHAPTER VII. 
 
 OF APHTHiE. 
 
 983. This complamt is generally called the baby's sore mouth : 
 it consists of a greater or less number of white vesicles on the in- 
 side of the mouth. It very generally begins on the inner part of 
 the lower lip, or corners, of the mouth, and much resembles a small 
 coagulum of milk. From this point, it sometimes spreads itself 
 very rapidly over the inside of the cheeks, tongue, and gums ; 
 and, at others, it will appear in the same form, and at the same 
 time, on several portions of the mouth ; as inner portions of the 
 cheeks, &c. When this efflorescence is extensive, the child sla- 
 
OF APHTHiE. 303 
 
 vers very much, and is frequently embarrassed in its sucking ; 
 it cries, and evidently betrays that it is in pain ; it is very restless 
 and very thirsty, as it evinces by its frequent stirrings, and its 
 disposition to be continued at the breast. The eruption in its 
 mildest form is very white, and looks as if a stratum of milky co- 
 agulum were spread over the mouth. It sometimes confines it- 
 self to the centre of the cheeks, at others to the lower lip, or one 
 side of the tongue. In its severer forms, the appearance of the 
 eruption is of a dark brownish colour, or extremely red ; owing, 
 most probably, to minute portions of blood; but both are evident- 
 ly grades of the same affection, changed either by mismanage- 
 ment, constitution, or the force of the remote cause. 
 
 984. This affection is thought to be altogether of a sympto- 
 matic kind — or very rarely idiopathic. It is almost uniformly 
 preceded by a deranged condition of the stomach and alimentary 
 canal, and alwavs, we believe, bv some disturbance of the sto- 
 mach itself. The brain always shows signs of participating in 
 this complaint, as there is almost always an unusual inclination 
 to sleep, though the child is frequently disturbed in its nap by 
 some internal irritation, perhaps of the bowels themselves. This 
 disposition to sleep is so well known to nurses, that they will fre- 
 quently tell you, " the child is sleeping for a sore mouth." The 
 bowels are often teased by watery, acrid stools, of a greenish 
 colour ; their discharge is frequently attended with the eruption 
 of much wind, and, to judge from the noise, it would be supposed 
 there was a very large discharge of faeces, though upon exami- 
 nation, it is found to be very sparing. 
 
 985. The alvine discharges are frequently very acrid, so much 
 so, sometimes, as to excoriate the verge of the anus and nates 
 very severely; especially when due attention is not paid to clean- 
 liness, or to the frequent changing of the diapers. The stomach 
 is also sometimes much deranged; vomiting the milk very soon 
 after it is received into the stomach, in the form of a dense curd, 
 mixed with a porraceous mucous substance. If the milk be not 
 voided by vomiting, the stomach constantly discharges, by eruc- 
 tations, a gas with a very sour smell. The child, when the dis- 
 ease is severe, soon becomes debilitated, and rapidly emaciates; 
 it is almost constantly harassed by severe colics, and profuse 
 diarrhoea; its stomach will scarcely retain the little it can swal- 
 low ; and the oesophagus sometimes becomes so loaded with 
 aphtha?, that it can no longer transmit the small quantity which 
 
304 OF APHTHA. 
 
 is reluctantly admitted into the mouth; and the child dies, either 
 from the exhaustion consequent upon the profuseness of the dis- 
 charges from its bowels, or from inanition. 
 
 986. It is a popular belief, that this aphthous efflorescence 
 passes from the mouth through the whole tract of the alimentary 
 canal, to the very termination of the rectum; and the excoria- 
 tion at this part is offered as evidence of the fact. Whether 
 this be true or not we do not know, for we are not in possession 
 of any facts from dissection which decide the point. We once 
 examined a body which certainly died from aphtha?, the exami- 
 nation of which would by no means tend to confirm this com- 
 mon belief. A child, on the tenth day after birth, was observed 
 to have a number of white spots upon several different portions 
 of its mouth, which rapidly spread over its whole surface. It 
 had the usual premonitory and accompanying symptoms, which 
 increased daily in severity, in spite of every effort to oppose 
 them. It was a feeble weakly child, of a consumptive feeble 
 mother. Its sufferings were very great, though under some con- 
 trol from laudanum, so long as it could be taken by the mouth, 
 or retained by injections — coat after coat of aphthae were thrown 
 off, and each new crop appeared to be more abundant, and less 
 amenable to remedies, until, at last, at the end of two weeks of 
 severe suffering, the poor infant could not swallow a drop of the 
 thinnest fluid. Injections of bark and mutton tea, in conformity 
 with popular opinion, were resorted to, but all in vain : the child, 
 in a few days more, died from absolute starvation, or, at least, 
 the catastrophe was certainly hurried by the impossibility of re- 
 ceiving nourishment. 
 
 987. We examined the body after death — we found the whole 
 tract of the oesophagus literally blocked up with an aphthous in- 
 crustation, to the sphincter of the cardia, and there it suddenly 
 stopped. The inner coat of the stomach bore some marks of in- 
 flammation, as did several portions of the intestines ; but not a 
 trace of aphthae could be discovered below the place just men- 
 tioned. This case would, therefore, create a doubt, whether this 
 affection besieges any other parts of the body than those just 
 stated, namely, the mouth, posterior fauces, and the oesophagus 
 to the sphincter of the cardia, since, perhaps, none could have 
 been of greater severity ; but it is with us a solitary case, and 
 should not be received for too much. Dr. Heberden says, " The 
 
OP APHTHA. 305 
 
 aphthae are supposed not only to infest the mouth and fauces, 
 but to be continued down through the whole intestinal canal. 
 In two who died of a lingering fever, and whose mouths were 
 covered with aphthae, which hung in rags all over it, there was 
 not the least trace of them that could be found in dissection be- 
 yond the fauces."*t The excoriations about the anus can cer- 
 tainly be accounted for, without the presence of aphthae to pro- 
 duce them ; in bad cases the stools are always extremely acrid, 
 and the parts over which they constantly pass and spread, are, 
 at such a tender age, very delicate, and very readily excited to 
 inflammation. 
 
 988. Dr. Good seems to admit, without hesitation, the trans- 
 mission of aphthae through the intestinal canal; for he says, with- 
 out reserve, " The fauces become next affected, and it descends 
 thence through the oesophagus into the stomach, and travels in a 
 continuous line through the entire course of the intestines to the 
 rectum, the' faeces being often loaded with aphthous sloughs. J 
 
 989. We are afraid there is too much taken for granted in 
 this account; we know of no decided evidence of the fact, nor 
 does Dr. Good name any authority for the statement. The case 
 alluded to was certainly one of death from aphthae ; but, in it, 
 the aphthous efflorescence stopped at the cardia. Is it probable 
 that any child could survive this affection, did it travel the 
 whole course of the intestinal canal ? We think not — yet aphthae 
 is rarely a dangerous disease in infancy. Dr. Good's description 
 of this affection would certainly lead to the conclusion, that it is 
 the ordinary march of the disease to pass through the bowels, 
 and manifest itself at the verge of the anus. 
 
 990. Now, this cannot be so ; since it is in violent and long- 
 protracted cases, alone, that the anus discovers any signs of ir- 
 ritation from this cause, which would not be the case, were 
 Dr. Good's account correct. 
 
 991. Dr. Good and others suppose that aphthae communicates 
 itself by a specific contagion; and give, as evidence, the excoria- 
 tions of the nurse's nipples. We do not hesitate to believe, there is 
 
 * Commentaries, p. 31. 
 
 + " It is well known, too, that in small-pox, no pustules are traced beyond the 
 pharnyx and larnyx, even in the most severe cases, when the mouth and tongue 
 are thickly covered with the eruption. " — Tweedie's Illustrations, p. 65. 
 
 * Study of Medicine, Vol. II. p. 391. 
 
 39 
 
306 OF APHTRiE. f 
 
 a discharge from these little pustules which may be highly acri- 
 monious to the denuded skin, but we think this is perfectly innox- 
 ious to a sound one. For we have never seen sore nipples pro- 
 duced by aphthae, where the skin of these organs was perfectly 
 sound. That they aggravate the tenderness and inflammation, 
 when these parts are tender and abraded, we admit, and so would 
 any other acrid substance, without having recourse to the belief 
 of a specific contagion. If this were the case, why do not the lips 
 of children, labouring under this affection, betray its influence? 
 
 992. That this complaint is occasionally epidemic, there is 
 every reason to believe ; and this circumstance, among some 
 others to be mentioned, render the opinion so commonly credited, 
 (of its being a sympathetic affection,) very questionable. We 
 have always considered aphthae as arising from some peculiar 
 condition of the stomach ; but, from some late cases, and more 
 mature reflection, we think it may be otherwise. Our reasons 
 for doubt are, 
 
 993. 1. We have recently seen this affection in two cases, 
 where the stomach and bowels were in the most perfect order 
 before the eruption; but became disturbed a little during the 
 progress of the disease. 
 
 994. 2. That this complaint has been very often removed by 
 topical applications alone, where the efflorescence has been very 
 considerable, and where there was no remedy of any kind ad- 
 dressed to the stomach and bowels. 
 
 995. 3. That we do not uniformly see this complaint where 
 there has existed great disorder of both stomach and bowels, 
 and these of a permanent kind. 
 
 996. 4. That, however the stomach and bowels may be dis- 
 turbed by acidity or other inconvenience ; or, however long these 
 may continue, if the child have had this complaint, it is not re- 
 newed, though the individual is not exempt from a second at- 
 tack, like measles or small-pox ; for, in certain chronic affec- 
 tions, they may be again visited by aphthae. 
 
 997. 5. That this affection is sometimes epidemic, as stated 
 above; for Dr. Good informs us, that " not only all the children 
 of the same family, however cautiously separated from one ano- 
 ther, but many of those of the same neighbourhood have been 
 known, at times, to suffer from it simultaneously." (Vol. II. p. 
 391.) 
 
 998. 6. That this disease is almost always ushered in by some 
 
OF APHTHAE. 307 
 
 cerebral affection; as great drowsiness, or watchfulness — the 
 first is by far the most common. 
 
 999. 7. That other portions of mucous membranes are liable 
 to the same kind of eruption, without the condition of stomach 
 or bowels being instrumental in its production; for we have 
 seen it most plentiful, within the labia pudendi, as well as on the 
 internal face of the prepuce. 
 
 • 1000. These facts have made us lately question the sympa- 
 thetic origin of aphthae ; yet we admit, they are not altogether 
 conclusive in our own mind; but we thought it proper to sug- 
 gest the possibility of its being an idiopathic disease of the mu- 
 cous membrane. 
 
 1001. This affection is not confined to early infancy; it shows 
 itself in the more advanced periods of childhood; and from that, 
 to any period of human life — it is sure to attend the last stages 
 of almost every long-protracted disease ; especially those which 
 may have wasting discharges; such as phthisis pulmonalis, 
 dysentery, or diarrhoea; and when it does appear, it is almost 
 sure to be a fatal harbinger. 
 
 1002. This disease is not essentially accompanied with fever: 
 if it accompany any chance affection, which is attended with 
 fever, we do not find it to heighten the existing one. 
 
 1003. Weakly children, and especially those born before their 
 full period, are more obnoxious to this complaint than the robust, 
 and those who have tarried to their full time in the uterus — the 
 children of weakly women, and particularly those who make bad 
 nurses from scarcity of milk, or from its not being of a sufficiently 
 nutritious quality, are more disposed to this affection than the 
 children of hale women, who have plenty of nourishment of good 
 quality. The children fed much upon farinacious substances, 
 (535, 536,) are especially exposed to the attack of this disease, 
 particularly when their food is sweetened with brown sugar or 
 molasses. 
 
 1004. The treatment of this disease must always be com- 
 menced by a regard to the stomach and bowels : there is, we be- 
 lieve, a superabundance of acid, which should be destroyed by 
 the use of absorbents. If there be no diarrhoea present, we are 
 almost certain of finding whatever evacuations there may be, 
 of a green colour; and when this is the case, small doses of mag- 
 nesia should be given, until the bowels are purged ; and this may 
 
308 OF APHTH-ffi. » 
 
 be repeated pro re ?iata. Should, however, the bowels be urged 
 to frequent dejections of a sparing watery kind, and especially 
 if attended with pain or straining, the following formula we 
 have long adopted with entire success ;— 
 
 B. Magnes. Alb. Ust. gr. xij. 
 
 Tinct. Thebaic. gtt. iij. 
 
 Sacch. Alb. q. s. 
 
 Aq. Font. ^j. M. 
 
 Of this a tea-spoonful is to be given every two hours, until the 
 bowels are more tranquil. Or, if green stools be frequently eva- 
 cuated, we may substitute a dram of prepared chalk for the mag- 
 nesia; or, if there be no fear of the diarrhoea weakening too much, 
 a scruple of the prepared chalk maybe added to the twelve grains 
 of the magnesia : by this combination, we ensure the destruction 
 of the acid, and prevent the lax from being too soon checked. 
 We have found, very often, great advantage from equal parts of 
 lime water and milk, where green stools continued, but without 
 diarrhoea — a tea-spoonful of this mixture may be given four or 
 five times a day. 
 
 1005. When the disease has proved obstinate, and the bowels 
 are much irritated by frequent, small discharges, and especially 
 if there be any streaks of blood, we have found the most decided 
 advantages from a tea-spoonful of the oil of butter given three 
 or four times a day. The oil of butter is prepared by putting a 
 lump of perfectly sweet butter into a tea-cup, and pouring on it 
 a quantity of boiling water, and agitating it well with a tea-spoon, 
 that it may be deprived of its salt — the oil is then skimmed off 
 as it is wanted ; should' it not be sufficiently fluid, pour off the 
 cold water each time, and add fresh warm water. The gum 
 Arabic water, made of an ounce of the gum and a pint of wa- 
 ter, is a most valuable remedy. 
 
 1006. During the continuance of this complaint, the child, 
 when practicable, should be confined to its mother's milk, if 
 this be of a healthy quality, otherwise the sooner a fresh breast 
 is acquired the better ; and the mother, or nurse, should at this 
 time avoid such diet as would become acescent on the stomach — 
 most of the common vegetables should be avoided, though she may 
 indulge freely in boiled rice with her meats at dinner — she should 
 abstain from all kinds of liquors, especially the fermented. She 
 may drink freely of rice water, toast water, or milk and water. 
 
OF APHTHA. 309 
 
 1007. We have constantly found in this complaint, that local 
 applications, when properly managed, are of the utmost conse- 
 quence; we,. therefore, direct their immediate use.* The best 
 we have ever tried, is, certainly, equal parts of borax, (borat 
 of soda,) and loaf sugar, rubbed together until very fine ; a 
 small quantity of this in its dry state is to be thrown into the 
 mouth, and repeated every two or three hours. This mixture 
 is quickly dissolved by the saliva of the child, and is soon car- 
 ried over the whole of the fauces. We should be very positive 
 in forbidding the mouth of the child to be rubbed with any thing 
 whatever, under the pretence of cleansing it. The cruel and 
 mischievous practice of scouring the mouth with a piece of flan- 
 nel, cannot be too strongly reprobated. We have seen a poor 
 little creature in agony, after it had undergone this rude disci- 
 pline from the heavy hand of an unmerciful nurse ; nay, we have 
 seen it bleed, even freely, from the barbarous treatment it re- 
 ceived under the specious pretence of doing it good. We are 
 persuaded, from many years' experience, that the mouth re- 
 quires no other washing or cleansing, than what may be pro- 
 cured from the application of the borax, and the frequent draughts 
 of the mother's milk. 
 
 1008. We do not, however, continue the borax, should the 
 efflorescence become discoloured ; we then generally employ the 
 Armenian bole in fine powder with loaf sugar, and use it as we 
 have directed for the borax ; but should this fail to give pretty 
 speedy relief, and particularly if the mouth be very red, livid, 
 or ulcerated, we have recourse to a weak decoction of the bark. 
 We order half an ounce of powdered bark to be stewed in half 
 a pint of water for twenty or five and twenty minutes over a 
 slow fire, and then permit it to settle ; about the third of a tea- 
 spoonful of this is put into the child's mouth, every hour or two 
 — as it is not agreeable to the child, it will not be much disposed 
 to swallow it ; bv which means it will be diffused over the whole 
 
 * Dr. Underwood differs with us upon this head, though we have no hesita- 
 tion to say that general experience is much in our favour. He says, "In regard 
 to applications to the part, it is necessary to observe, as they have little to do in 
 curing of the complaint, it will be improper to have recourse to them very early." 
 Yet, a little farther on, he confesses that he has " met with an instance of a very 
 copious thrush disappearing after clearing the mouth with borax and honey, at 
 noon and at night, on the fourth day of the disease." 
 
310 OF COLIC. 
 
 mouth — we have often seen this attended with the most marked 
 advantage. 
 
 1009. During the continuance of this complaint, the most 
 scrupulous attention should be paid to cleanliness — the child's 
 nates should be washed with flaxseed tea after every evacua- 
 tion ; and the excoriated parts should be constantly defended by 
 a coat of fine hog's lard, or the best quality of soft pomatum. 
 The same diaper should not be used twice without washing. 
 
 CHAPTER VIII. 
 OF COLIC. 
 
 1010. Owing to improper feeding, or the peculiar quality of 
 the mother's milk, or, perhaps, in some instances to the particu- 
 lar constitution of the child, it becomes liable to severe attacks 
 of pain in the bowels, which continue for several hours, with 
 great suffering to the poor infant. These colics are of two 
 kinds — 1st, those which attack the child at any time of day, 
 without evident cause; and, 2dly, those that observe a periodi- 
 cal movement. 
 
 1011. In the first, the child may be seized at any time of the 
 day without our being able to trace the cause to any evident 
 source. This kind generally attacks children of feeble constitu- 
 tions, and though the mother may have plenty of milk, and the 
 child may suck it very freely, yet it does not thrive ; or it may 
 attack children situated the very reverse of the one just de- 
 scribed — here the child has not sufficient nourishment from the 
 mother, or it is of bad quality : to supply the first defect, the sto- 
 mach is overloaded with crude or improper diet, which not only 
 fails to afford it a healthy nourishment, but quickly turns acid, 
 to the decided injury of the child. Perhaps diarrhoea, with green 
 stools, is produced; or it may not have too many evacuations, but 
 they are evidently the remains of ill-digested food. When pain 
 arises from the use of improper food, the child almost always be- 
 comes uneasy as soon as it swallows it ; and if it arise from ill- 
 elaborated milk, it complains as soon as it is done sucking. 
 Its little abdomen becomes swollen and tense, and it writhes 
 
OF COLIC. 311 
 
 its body as if in the utmost agony. It sometimes becomes sud- 
 denly relieved, by eructating a considerable quantity of wind; 
 or it passes downwards, carrying with it a very small portion 
 of faeces. 
 
 1012. It is obvious, that we must change the diet of the child, 
 or alter the mother's milk, if we expect to relieve this complaint. 
 We have already said enough on the subject of diet for young 
 children, and need not repeat it here. When we are satisfied it 
 is from the quality of the food that this complaint proceeds, it 
 would always be advisable, if it were always practicable, to con- 
 fine the child altogether to the milk of the mother ; to destroy 
 acidity by small doses of magnesia, especially if there be costive- 
 ness, as is sometimes the case. A small tea-spoonful of warm 
 sweet oil, three or four times a day, is a remedy very often of 
 great value. Should it depend upon the mother's milk, an at- 
 tempt should be made to alter its quality, by an almost total 
 change of diet, and well regulated exercise. If this do not suc- 
 ceed, we are obliged to have recourse to temporary remedies, 
 rather than witness hourly the sufferings of the afflicted infant. 
 This complaint most frequently commences in the month, but 
 when it may cease it would be difficult to say. 
 
 10J3. We have sometimes been so fortunate as to succeed 
 completely in curing this complaint, by the plan just suggested; 
 but it requires the strictest attention to attain success, and this 
 continued for some time most perseveringly. Care should be 
 taken that the child do not remain wet for a long time after its 
 evacuations, from an unfounded opinion that it makes them 
 hardy to use them to cold. By this management, the feet and 
 legs become chilled ; and the bowels, in consequence, are made 
 to suffer a double portion of torture. During, however, the trial 
 of changing the food, we must temporize, and administer imme- 
 diate relief to the sufferer : for this purpose, we have been in 
 the habit of employing the following mixture, with the most de- 
 cided advantage ; it rarely failing to give instant relief, and some- 
 times, effecting an entire cure: — 
 
 R. Magnes. Alb. Ust. 9j. 
 
 Tinct. Foetid. gut. lx. 
 
 Theb. gut. xx. 
 
 Aq. Font. |j. M. 
 
 Of this twenty drops are to be given in a little sweetened water, 
 when the child is in pain ; and, if not relieved in half an hour, 
 
312 OF COLIC. 
 
 ten drops more are to be administered. This dose is calculated 
 for a child from two weeks to a month old. If it be older, a few 
 drops more must be given; and as the child advances in age, or 
 becomes accustomed to its use, the proportions of the ingredients 
 must be a little increased. We must, however, caution against 
 a too rapid increase of the dose; as this is by no means necessa- 
 ry; and it would be wantonly subjecting the child to the use of 
 a medicine, which should only be given when pain demands its 
 exhibition. 
 
 1014. The other form under which we are to consider this 
 complaint, is, where it becomes distinctly periodical. It very 
 often, however, commences with the erratic form, and after con- 
 tinuing in this state for some time, it settles down to a certain 
 period of the day; this is usually from four to six o'clock in the 
 afternoon. Generally speaking, this form does not appear to be 
 so injurious to the health of the child as the other ; indeed, it 
 seems that the child even thrives with it, so that one might al- 
 most say,- it is " cryand be fat." Certain it is, that some of the 
 fattest and healthiest-looking children are troubled with it. We 
 have never found the diet of either the mother or child to have 
 much effect upon this form of the complaint, and in this it differs 
 materially from the fiflst. It would seem to depend upon some 
 constitutional peculiarity, over which we have but a temporary 
 control ; as it very frequently will stop of itself, as soon as the 
 child reaches the age of three months: hence the old women 
 say, the child has " the three months' belly-ache." 
 
 1015. The child who is subject to this complaint, is usually 
 habitually costive; but we have never, we think, derived any ad- 
 vantage from the exhibition of purgative medicines : indeed, we 
 think this in general to be a bad plan. When the constipation 
 is more than usually protracted, we order a little opening me- 
 dicine, of a mild kind, such as sweet oil, or the castor oil, si- 
 rup of rhubarb; or manna, as sweetening in the food, when the 
 child feeds ; or we direct an injection of molasses and water, 
 or the introduction of a suppository of soap. 
 
 1016. For the immediate relief of the child, we give it the 
 mixture, as just prescribed : only observing, it should be admi- 
 nistered the instant the paroxysm is about to commence. Con- 
 sidering this as a true periodical disease, we have given a de- 
 coction of the bark for it, with the happiest effect, in several in- 
 
OF COLIC, 313 
 
 stances; but it has not always succeeded.- This complaint 
 should excite but very little apprehension, as we believe it is 
 never dangerous, and is almost sure to wear itself out after a 
 certain period. 
 
 1017- We will relate a curious instance of the influence of an 
 aching tooth upon the secretion of milk, and its indirect agency 
 
 in producing the " belly-ache " of the first form. Mrs. was 
 
 delivered of a fine healthy-looking boy, which appeared to do 
 perfectly well for the first tw r o weeks after birth. At this time 
 it became uneasy, and frequently cried — the usual domestic re- 
 medies were from time to time employed for its relief, without 
 the smallest benefit. The complaint seemed to increase every 
 day ; the pain became more severe, and longer continued, the 
 stomach and bowels were affected ; the one with sour vomitings, 
 the other by frequently discharging green stools. The child 
 could obtain no relief but from laudanum, and this we were 
 obliged to give in large and constantly increasing doses. The 
 emaciation was so great, as to render the child lighter at three 
 months old, than when first born. In this situation did things 
 continue, without much aggravation or amendment, until the 
 child was five months old. By this time it was, (without a 
 figure,) nothing but skin and bones. 
 
 1018. At one of our visits we observed the mother apply her 
 hand very suddenly to her face, and press it forcibly, as if in 
 pain from a tooth — we inquired of her what she ailed ; she in- 
 formed us, she was very much tormented, both by day and by 
 night, with toothach, and had been for some time before the 
 child was born, and ever since. We immediately declared our 
 opinion, that this was the cause of the affliction of her child — 
 the constant pain she was enduring, and the great loss of sleep, 
 so affected her stomach, and indirectly the breasts, that they 
 could not yield a healthy nourishment. We advised her to send 
 
 * We have lately succeeded, in two instances, in arresting this distressing" com- 
 plaint by the use of the sulphate of quinine. The paroxysms occurred in the after- 
 noon about four or five o'clock; and they would continue several hours with great 
 violence. The following prescription was employed: — 
 
 v. Sulph. Quinine, gr. iss. 
 
 Sacch.Alb. ^iss. 
 
 Aq. Font. 3,j. fo. sol. 
 
 A tea-spoonful every hour, in the absence of pain, 
 
 40 
 
314 OF OFHTHALMIA. 
 
 immediately for a dentist, and have the tooth extracted — this 
 was accordingly done ; and from that day the child began to re- 
 cover, and in a short time was perfectly restoYed to health. 
 
 CHAPTER IX. 
 • OF OPHTHALMIA. 
 
 1019. From about the fourth to the seventh or eighth day, or 
 sometimes longer, after delivery, (he eyes of the child are found 
 to inflame ; they are first observed to glue up in the morning, 
 and quickly after the whole of the lids become swelled, and, 
 especially, in the early part of the day, or until the eyelids have 
 become unclosed, and given issue to some purulent matter, the 
 eyes themselves are soon found to partake of the inflammation 
 of the lids, and have a peculiarly fiery appearance ; the child now 
 keeps its eyes entirely closed, or closes them at the approach of 
 even a weak light. After a plentiful secretion of pus has taken 
 place, which generally happens after the third or fourth day, the 
 lids during the night become pretty (irmly attached to each other, 
 in consequence of the discharge from them becoming inspissated 
 and thus glueing them firmly together : this permits a consider 
 able accumulation of pus behind them, which distends the up 
 per eyelids, especially, very considerably, and swells them some 
 times even with the socket. Upon moistening the eyes with 
 warm water, the lids are enabled to separate, which permits a 
 considerable quantity of pus to discharge itself, -^the eyes now. 
 seem to swim in pus, and the dark parts of them can no longer 
 be seen. The whole of the internal linings of the eyes, which 
 become exposed upon separating the lids, is of a bright scarlet 
 red, manifesting an intense degree of inflammation, which, if not 
 interrupted by very active remedies, runs on to disorganization, 
 and total blindness. 
 
 1020. The remote cause of this complaint is some foreign 
 matter they acquire in transitu — this may be the matter of go- 
 norrhoea, or leucorrhcea. 
 
 1021. This disease may, therefore, with much propriety, be 
 called " the purulent ophthalmia.'' It would seem, that it could 
 only arise, at the age at which it appears, from the application 
 
OF OPHTHALMIA. 315 
 
 of some foreign matter, as of leucorrhoea, or gonorrhoea. We 
 are firmly persuaded, that one or other of these matters is the 
 cause of the affection under consideration ; and for the following 
 reasons : — 
 
 1022. 1. Because it always makes its appearance within ten 
 or twelve days after birth — a period in which such a cause 
 might be suppQsed to act. 
 
 1023. 2. Because in every instance in which w T e have met 
 with this affection, we have learnt, upon inquiry, that the mo- 
 ther was subject to leucorrhoea ; and in some few instances, in 
 loose characters, to gonorrhoea. 
 
 1024. 3. The suddenness, extent, and severity of the inflam- 
 mation, together with the profuseness of the suppuration, would 
 seem to denote the application of some violent irritant to this 
 tender and susceptible organ. 
 
 1025. On this account, at the first washing, we direct the 
 nurse, when we know or suspect this condition of the mother, 
 to be very particular in applying plenty of^water to the eyes. 
 We have taught this doctrine of the remote causes of purulent 
 ophthalmia, for more than thirty years, and have recommended 
 the plan of freely washing the eyes, for the same period ; and 
 we have reason to believe we have in some instances prevented 
 it altogether, and in others have rendered it much lighter. In 
 one case, where we knew gonorrhoea to be present in a violent 
 degree, we prevented this affection almost altogether, by very 
 carefully having the eyes washed with warm water for fifteen 
 or twenty minutes, and pouring it upon the eyes in a full stream. 
 The eyes suffered, however, a little; a slight inflammation su- 
 pervened, but was relieved in two or three days by the mucilage 
 of sassafras alone. We are of opinion, however, that the in- 
 convenience the eyes suffered, may be pretty justly attributed 
 to the discipline they underwent in washing. 
 
 1026. The mode of treatment is, perhaps, precisely the same 
 in both instances — or, at least, we know of no substance that 
 will more certainly control the inflammation of gonorrhoea than 
 that arising from leucorrhoea ; unless in desperate cases of the 
 former, we might apply some mercurial preparation — for in- 
 stance, three or four grains of calomel suspended in an ounce 
 of gum Arabic solution, and applied three or four times a day, 
 in addition to the remedies we shall presently mention. But 
 this is altogether hypothetical. 
 
'310 • OF OPHTHALMIA. 
 
 1027. Nothing can be more unsatisfactory, than Dr. Under- 
 wood's description of ophthalmia purulenta, nor any thing more 
 vague than his plan of cure, if it even deserve that name. In- 
 stead of ordering his remedies to the different stages of the com- 
 plaint, and pointing out the time, and the sigr^ by which the 
 time might be known at which it would be proper to change 
 them, he confounds, under one general direction, opposite and 
 incompatible remedies. 
 
 1028. After vaguely describing the disease, as just stated, he 
 recommends in one breath, purging, leeching, and blistering, to 
 the back, neck, and behind the ears ; the last to be renewed every 
 three or four days. " The edges of the eyelids should be greased 
 throughout the day; at night, a lead-water poultice ; but if the 
 eye be affected by the weight' of the poultice, it must be re- 
 moved, for rags dipped in cold brandy and water, or some other 
 more astringent lotion." He then adds, 
 
 1029. "Throughout the complaint, astringent and stimulating 
 applications are to be made use of, unless the complaint be un- 
 usually slight, or sensibly give way very soon to mere greasing 
 the lids, as it sometimes will." And then gravely declares, 
 that " should emollient poultices, and merely cooling collyria 
 be depended upon, the event were likely to" be fatal." 
 
 103Q. I would ask any inexperienced practitioner, if he could 
 possibly attempt to cure this formidable inflammation by the 
 direction just given? At one moment, the eyes are to have blood 
 extracted from them; then they are to have astringent and stimu- 
 lating remedies applied to them: "For if you depend," says the 
 Dr., "upon merely cooling collyria and emollient poultices, the 
 event may be fatal." Yet he directed, just before, that the eye- 
 lids should be greased at night, "which will very often cure the 
 disease alone." We are of opinion, that no greater error can 
 wellbe committed, than the too early use of astringent or stimu- 
 lating collyria. We are persuaded we have seen several eyes 
 destroyed by their ill-timed use. 
 
 1031. Mr. Burns also recommends, in the beginning of this 
 disease, "some astringent solution;" than which, we feel it our 
 duty to say, there cannot well be a more hurtful application. We 
 have been called in consultation several times, where the plan of 
 Dr. Underwood and Mr. Burns had been employed; and, from 
 the state of the eyes when we first saw them, we are altogether 
 Convinced, that the stimulating or astringent collyrium had done 
 
OF OPHTHALMIA. 3 1 7 
 
 irreparable mischief. We are, therefore, persuaded, (hey never 
 can be successfully employed, but after considerable abatement 
 of the inflammation. Even blisters, when used too early, are 
 oftentimes mischievous, though highly important in the progress 
 of the cure. 
 
 1032. This case must be actively pursued by remedies, if any 
 good is to be derived from them; there is no time to temporize; 
 and the most vigilant attention must be paid to the eyes, or they 
 quickly perish. We should commence our plan by leeching — 
 about three common-sized ones should be applied to each eye, or 
 rather to the temples (if both be affected ;) the bleeding from the 
 leeches should be encouraged for some time by the application 
 of a soft bread and milk poultice, Confined between the folds of 
 fine linen. After the weeping from the leech wound ceases, the 
 eyes should be exposed to the air in a very dark room, and 
 should be kept cool by a very weak solution of the acetate of 
 lead in rose water, in the proportion of two grains of the former 
 to an ounce of the latter. This is best employed by washing the 
 surface of the eyes frequently, with a fine piece of linen rag, wet 
 with the solution. The eyes should not be bandaged up, as heat 
 does much mischief. Should the eyes betray a disposition to 
 glue up, notwithstanding the frequent moistening, care should be 
 taken to prevent it, by washing them carefully with the mucilage 
 of the pith of sassafras, every hour or two. We should keep 
 the bowels freely opened, or rather purged ; and for this purpose, 
 we have round the following answer extremely well: — 
 
 R. Calom. ppt. gr. iv. 
 
 Magnes. Alb. Ust. gr. viij. 
 
 M. div. in viij. 
 
 i 
 
 One of these powders to be given morning and evening, mixed 
 in a drop of any common sirup. Should this quantity not purge 
 sufficiently, let another powder be given — should this operate 
 too freely, give but one. 
 
 1033. If the inflammation be not abated by these means in the 
 course of forty-eight hours, the leeching should be repeated, and 
 the other treatment recommended strictly followed. As soon as 
 the violence of the inflammation is overcome, we should apply 
 a blister to each temple, which should be encouraged to dis- 
 charge by dressing with basilicon or weak savin ointment. Dr. 
 
318 OF OPHTHALMIA. 
 
 James* says, that " blisters have occasionally been applied over 
 the closed eyelids, with the best effect." We can say nothing 
 of this from our own practice, but it can be safely relied upon, 
 coming from such authority. 
 
 1034. After the disease is so much weakened as to permit the 
 child to open its eyes in a dark room, we may safely begin to 
 use some weak, mild collyrium with advantage ; the best that 
 has presented itself to us, is a very weak solution of the acetate 
 of zinc, as follows: — 
 
 R. Acetas Zinci. gr. ij. 
 
 Aq. Rosar. ^ij. ft. sol. 
 
 The eyes to be washed with this four or five times a day.t 
 
 1035. It is found to be very useful to wash the matter from 
 the eyes by injecting warm soft water between the lids, three 
 or four times a day, by means of a small syringe. The mo- 
 ther's milk is also thought to be very useful in preventing the 
 eyelids from sticking together, by being frequently milked upon 
 them. 
 
 1036. The child is sometimes afflicted with pain in the bowels, 
 which occasions it to cry very much, this should be prevented 
 by giving it a little mild anodyne of almost any kind, half a drop, 
 to a drop of laudanum in a little sweetened water ; or a little of 
 Dalby's carminative from time to time, will be found a very 
 good substitute for the laudanum, or the mixture prescribed 
 above (1013) which will not produce constipation. 
 
 * Burn's Midwifery, Vol. II. p. 32. Note. 
 
 f The stage of the inflammation, constitutes an essential point in the treatment 
 of ophthalmia: and when this is lost sight of, much mischief is oftentimes done. 
 Thus, the experiments of Wilson, Philip, Hastings, Gendrin, and Broussais, have 
 ascertained that immediately after the application of any irritating substance to a 
 susceptible surface, the circulation in the vicinity of the stimulated part becomes 
 much more rapid, while the calibers of the vessels become considerably dimi- 
 nished. But at a certain period after the irritation has caused an increased flow 
 of blood to the part, other phenomena present themselves. The capillaries be- 
 come gradually enlarged; the circulation becomes retarded, and if the congestion 
 continue, the blood becomes stagnant. But, should the congestion be diminished, 
 the blood gradually recovers its mobility, and the dilated vessels recover their 
 natural size, and the circulation resumes its wonted activity. It was, however, 
 found, that a second stimulus, to the congested part, served to dissipate the ac- 
 cumulation of blood, caused by the first stimulus. Hence, the utility of this mo- 
 derately stimulating collyrium in the stage of the inflammation at which it is re- 
 commended. The nitrate of silver in solution, in the proportion of one grain to 
 the ounce of distilled water, is highly spoken of in this state of the inflammation. 
 
cuf ULCL^ xiuH OF THE MOUTH. 319 
 
 CHAPTER X. 
 OF THE ULCERATION OF THE MOUTH." 
 
 1037. Children are frequently troubled with ulcerations of the 
 mouth ; it oftentimes confines its attack to the inferior portion 
 of the frasnum of the tongue. It usually commences by a small 
 inflamed point, and pretty rapidly extends itself along the infe- 
 rior margins of the tongue, or rather the loose cellular portions 
 of the skin to which the tongue is united — it seldom attacks the 
 tongue itself, and for the most part confines its ravages to the 
 gums, but especially to the cheeks, and the frsenum and its de- 
 pendencies, where it most commonly commences. The edges 
 of the sores are generally pretty high, and much inflamed, and 
 the ulceration deep in proportion to its surface, and very painful. 
 
 1038. The child is first noticed to slaver very much, and to 
 become fretful and uneasy, especially when it is about to take 
 the nipple, which it frequently seizes, and then lets it go with a 
 whining cry, as if in pain. Fever almost always is present at 
 the beginning of the complaint, but pretty soon subsides after 
 the ulceration has taken place, and the drivelling has become 
 pretty considerable. The bowels are almost always confined, 
 and the palms of the hands unusually warm. 
 
 1039. The complaint is generally of pretty easy manage- 
 ment, if it be attended to at a proper time, or before the ulce- 
 ration is extensive. Before we use any topical application for 
 this complaint, and particularly if the febrile state be not pass- 
 ed, we should purge the child freely by magnesia, or small doses 
 of calomel, and this plan should be continued until the system 
 be free from fever. After the bowels are well emptied, or there 
 is no longer fever, we may use topical applications with great 
 profit. The following has, so far, never failed us : — 
 
 R. Sulph. Cupri. gr. x. 
 
 Pulv. C. Peruv. opt, - - 5ij. 
 
 G.Arab. - Jj. 
 
 Mel. Commun. - 3'j* 
 
 Aq. Font. - - - 5iij. m. et f. sol. 
 
320 OF ULCERATION OF THE MOUTH. 
 
 The ^ulcerations are to be touched with this mixture and so- 
 lution twice a day, with the point of a camel's hair pencil. 
 This has always speedily put a stop to the disease. 
 
 1040. There is another ulceration of the mouth, and espe- 
 cially the gums, which takes place in children who are cutting 
 their teeth, and particularly the back teeth, when a number are 
 about to make their appearance together; this is a very different 
 state of the mouth from the one just noticed. In this complaint 
 the gums become swollen, very dark-coloured, and spongy; 
 they bleed from the slightest force ; the child drivels constantly ; 
 the breath is extremely offensive ; and there is always more or 
 less difficulty in swallowing. The teeth that are cut at the time, 
 soon decay; and those which w r ere through before the ulceration 
 commenced, become injured. We have rarely found any other 
 treatment necessary, than cutting the gums, and having the 
 mouth frequently w T ashed with a pretty strong decoction of 
 
 bark. 
 
 1041. Dr. Underwood calls this affection of the mouth aphtha 
 
 gangrenosa, and has given a very good general description of it ; 
 and why it should be classed with aphtha, we are at a loss to un- 
 derstand. For the aphthous appearance spoken of by Dr. Un- 
 derwood, we have never witnessed — that is, we have never seen 
 real aphthae attend this complaint. We have frequently ob- 
 served the little dark-coloured sores he speaks of, but they do 
 not bear the slightest analogy to aphthae. It is a disease of the 
 gums arising from cutting the last of the first set of teeth — it, 
 therefore, never attacks after this process is completed ; or, at 
 least, not until the teeth of second dentition are about to appear. 
 The gums first swell violently, and become of a very dark red ; 
 they are so extremely tender, as to make the child refuse its 
 food, or sometimes even the mildest drinks. After the inflam- 
 mation has continued several days, the parts of the gums im- 
 mediately over the teeth, about to be protruded, give way by 
 ulceration to a greater or less extent. Other portions of the 
 gums will now be subject ta the same process, so that nearly 
 the Whole mouth will be in a state of ulceration. 
 
 1042. This disease, Dr. Underwood says, is never dangerous ; 
 we have never seen a fatal termination of it ourselves ; though 
 we have seen it protracted to a great length of time, especially 
 with children who have had bad teeth. 
 
INFLAMMATION AND SWELLING, &C. 321 
 
 CHAPTER XL 
 
 INFLAMMATION AND SWELLING OF THE BREASTS 
 OF NEW-BORN CHILDREN. 
 
 1043', It occasionally happens, that children newly born are 
 found to have their breasts swollen, and evidently inflamed. This 
 exists in various degrees, from a slight tumefaction, to one that 
 threatens suppuration. 
 
 1044. There is a vulgar opinion, that these enlargements pro- 
 ceed from a quantity of milk within these little bodies, which 
 must be squeezed or milked out, that mischief may not follow. 
 This absurd opinion has, unfortunately, led to the preposterous 
 and mischievous practice just alluded to ; in consequence of which, 
 the parts have become so irritated, as to occasion much pain, and 
 increase of inflammation. The little tumour has been violently 
 pressed with the view to force out impacted milk; but being dis- 
 appointed by its not appearing, the pressure is renewed again 
 and again, and each effort with an increase of force ; since, agree- 
 ably to them, if the cause be not removed, serious consequences 
 will follow to the parts, and, perhaps, in females, for ever destroy 
 their usefulness. In thus pursuing a bad theory, by a worse 
 practice, the consequences which they so much dreaded, have 
 absolutely taken place; suppuration has sometimes followed these 
 rude manoeuvres, and has for ever destroyed the organization 
 of these most useful parts. 
 
 1045. Or, should the inflammation be controlled by the use of 
 suitable remedies, and thus prevented from running on to suppu- 
 ration, still so much mischief has been done these parts, by rough 
 handling, as to destroy their organization ; or so much to injure 
 it that they never can serve the purposes for which they were 
 intended. 
 
 1046. It cannot, therefore, be too peremptorily forbidden, 
 that these parts should be meddled with ; for all that is necessa- 
 ry to their restoration, is a little time ; or the application of a 
 piece of linen, moistened with a little sweet oil, unless the tumours 
 be unusually large, and the inflammation very considerable. In 
 
 41 
 
322 OF DENTITION. 
 
 this case, a bread and milk poultice, renewed every three or 
 four hours, will be almost sure to restore them to health in a few 
 days. 
 
 1047. We have never seen any other treatment necessary; 
 where the parts had not been ill managed by an ignorant and 
 over-officious nurse; but we have, in two instances, after misma- 
 nagement, been obliged to leech the parts, and continue poul- 
 ticing for some time after. It would be difficult to say, how 
 these swellings are formed, especially as they are almost always 
 congenital, or rather connate. 
 
 CHAPTER XII. 
 
 OF DENTITION. 
 
 1048. We have already spoken (page 204) of this operation, 
 as one among the important acts of the system; therefore, we 
 shall not repeat here the order of the appearance of the teeth, 
 nor the process by which this change in the condition of the 
 mouth is effected. We shall now confine ourselves to the mor- 
 bid phenomena of this process, and the best modes of relieving 
 them when they occur. 
 
 1049. One of the most remarkable circumstances attending 
 teething, is the variety of sympathetic affections it gives rise to; 
 so that from the number, and oftentimes from their severity, this 
 act of the system is one of great suffering, as well as oftentimes 
 one of great danger. 
 
 . 1050. The calculations of the mortality of children at this pe- 
 riod, have always to us appeared to be excessive ; some, as Dr. 
 Arbuthnot, making it one in every ten, others, one in every six. 
 That many children die at this time, must be acknowledged; 
 but it should be recollected, that, at this period of life, children 
 are subject to many other complaints, besides teething, to which 
 they may fall sacrifices. Yet we are willing to admit, that the 
 act of teething, abstractly considered, has sometimes severe 
 penalties attached to it; and but too frequently disturbs the 
 system, and calls into action many latent dispositions to disease, 
 
OF DENTITION". 323 
 
 Which otherwise might have slumbered to a more remote pe- 
 riod, or have been finally overcome — therefore, in most instances, 
 teething is but indirectly concerned in producing the formida- 
 ble mortality of children at this age. 
 
 105 ] . Teething is instrumental, sometimes, in producing death, 
 by the condition in which the act itself places the system ; by 
 exciting fever, or by disturbing the natural functions of the ali- 
 mentary canal; therefore, when the child is attacked by any 
 acute disease, that disease is almost certain to be aggravated 
 by the existing condition of the system. Hence the mortality 
 of the small-pox, measles, hooping-cough, &c, at this period. 
 Yet it cannot be truly said, that many diseases are necessarily 
 connected with the acquisition of teeth. 
 
 1052. The same may be said of certain chronic affections; 
 as scrofula, glandular swellings, consumption, rickets, &c. If 
 either have been developed before this period, they are now 
 sure to be aggravated, and the child but too frequently suc- 
 cumbs ; or, if they have not been previously developed, they 
 are now but too often called into action. 
 
 1053. The system at the period of teething is more irritable, 
 as well as more feeble, than in the after periods of life — hence, 
 when several teeth are making their way through the gums at 
 % once, it will suffer more than when this process proceeds slower ; 
 and if the. body at this moment be attacked by fever, or con- 
 vulsions; or if there be a disposition to either, they may be ag- 
 gravated, if present, or called into action, if predisposed by the 
 condition of the gums. 
 
 1 054. But the teething should not be chargeable with these 
 contingencies ; since it is itself altogether a functional process, 
 as much so as the formation of the bones in other parts of the 
 system, or of any other parts belonging to the human body. 
 
 1055. There are two states of the constitution, which may 
 render this period one of greater suffering, or even of danger, 
 than, where neither of these obtain — namely, where there is a 
 decided and marked feebleness ; and where there is evidence of 
 a preternatural susceptibility to stimuli, though there may be 
 the appearance of great vigour, and firmness of constitution. 
 Now, should these states not be relieved, as they may be, by 
 proper physical treatment, the act of teething may create much 
 mischief by its operation upon both the nervous and sanguife- 
 rous systems. 
 
324 OF DENTITION. 
 
 1056. We have, in the first part of this work, directed the 
 best mode of management for these two different temperaments 
 — the first should enjoy a pure and temperate atmosphere, botk 
 at home and abroad; strict attention to cleanliness; proper diet 
 or nourishment, and especially that of a mother or nurse; well 
 regulated clothing ; so that they shall not suffer too much by 
 the winter's cold; nor be too much oppressed by the summer's 
 heat; and by well-directed exercise. 
 
 1057. The other must have its excess of irritability diminished 
 by withdrawing every thing capable of fostering it ; as too uni- 
 formly warm a temperature ; by the abstraction of all unneces- 
 sary stimuli, from within; as that of animal food, spices, and li- 
 quors of every kind; by not sleeping' too warm at night, or too 
 long indulgence of bed in the morning; by a regular and efficient 
 exercise ; especially such as will agreeably occupy the mind, as 
 well as employ all the muscles of the body, &c. (See Chap, 
 on Exercise, p. 228.) 
 
 1058. We -are, however, not to be understood as underrating 
 the dangers attendant upon teething ; and though we are not 
 disposed to consider teething in itself a disease, we are, never- 
 theless, well aware it invites such as may not be present, and 
 aggravates those absolutely existing; consequently, it must be 
 considered as a period of great moment to the poor child. On 
 this account it is every way important to point out both the ex- 
 tent of the influence of this act, and the numerous morbid sym- 
 pathies to which it may give rise. 
 
 1059. We have already described the order in which the teeth 
 make their appearance, (Book I. Chap. VIII. p. 202,) and pointed 
 out the principal local phenomena which accompany this func- 
 tion; we shall now advert to some of the most common morbid 
 sympathies by which it is attended. These are, 1st, eruptions 
 on the skin; especially on the face and scalp; 2dly, tormina of 
 the bowels, accompanied by a diarrhoea with various-coloured 
 stools ; as green, very pale yellow, clay-coloured or a peculiar 
 dark brown,which leaves a very permanent stain of a black colour 
 upon the diaper; 3dly, spasms in various parts of the body, espe- 
 cially when passing from the waking to the sleeping state, or 
 starting when asleep; 4thly, an increased or diminished quantity 
 of urine, of various complexions, attended with great pain in 
 
OF DENTITION. 325 
 
 making it, and sometimes a discharge resembling pus from the 
 urethra; 5thly, partial palsy of the arms or legs; 6thly, cough 
 and difficulty of breathing; 7thly, convulsions ; 8thly, fever, &c. 
 We once saw a case where violent crouping symptoms would 
 appear whenever a tooth was about to be cut; and these would 
 cease when the gums were scarified, or when a tooth would 
 come through. 
 
 1060. As a general remark, it may be observed, that the chil- 
 dren of the firmest constitutions cut their teeth the earliest and 
 the easiest — we must, however, admit exceptions to this rule. We 
 have lately had under our care a child with a diseased spine, who 
 cut a number of teeth before she was four months old. We have 
 already noticed the departures from this rule, as well as the one 
 which governs the order in which the teeth make their appear- 
 ance. (See Book I. Chap. VIII. p. 202.) 
 
 1061. We have never distinctly perceived the advantage of 
 very early dentition; for if it be a sign of more vigour of consti- 
 tution, it nevertheless has, from this very cause, its penalties — 
 hence, the frequency of fever, and other diseases of irritation. 
 
 1062. Much of the difficulty that attends painful dentition, 
 may be removed, as already suggested in various parts of our 
 first book, by a proper attention being paid to air, exercise, food, 
 bowels, &c. ; for if these be duly regulated, the system will be 
 less disposed to morbid action ; though the local symptoms, such 
 as swelling, redness, and inflammation of the gums, be consider- 
 able : and if proper care be bestowed upon the mouth, the force 
 of the latter symptoms may be very much abated. 
 
 1063. Indeed, this important part of parental and medical duty 
 should never be lost sight of; the mother should carefully in- 
 spect the situation of the child's mouth, from time to time ; and 
 should she discover a swollen gum, she should immediately 
 have it attended to, and not wait for constitutional symptoms 
 to appear, before she employs proper aid for her child. 
 
 1064. Should she not be familiar with the appearance of the 
 gums under distention and inflammation, she will, at least, be 
 aware, that this condition is accompanied by slavering, heat of 
 the mouth, &c ; which should give rise to the suspicion that the 
 eruption of teeth is about to take place, if the age of the child 
 will justify the supposition ; or, if it have some teeth, that others 
 are about to appear. 
 
326 OF DENTITION. 
 
 10G5. However truly the slavering of children may denote 
 the cutting of teeth in general, the rule is not infallible. We 
 have seen children drivel largely at three months old, and con- 
 tinue to do so for months, without a single tooth making its ap- 
 pearance. From this circumstance we are led to believe this 
 sympathetic affection may denote the formation and hardening 
 of the tooth, as well as its being about to pierce the gum : for 
 when the investing membrane of the tooth is put upon the stretch 
 by the increased size, and hardening of this body, it may possess 
 an unusual degree of irritability, or sensibility, and thus give rise 
 to several of the premonitory symptoms of this operation, be- 
 fore the gums are at all acted upon by its presence — hence, 
 the slavering, the frequent thrusting of the fingers into the 
 mouth, &c. 
 
 1066. We have thought it proper to state this fact, because 
 we have seen it produce much anxiety in parents ; especially if 
 the subject be a first child ; and it sometimes leads, at this mo- 
 ment, to the unnecessary expedient of having the gums of the 
 child cut, before the lancet can well reach the crown of the tooth, 
 however deep the incision may be made. We would, therefore, 
 wish to spare the poor infant this unprofitable pain, since it is 
 both unnecessary and unavailing ; for we have seen the whole 
 of the symptoms for which the operation was performed, con- 
 tinue with as much pertinacity, after this has been done, as be- 
 fore the gums were incised : therefore, this operation should 
 not be had recourse to without the advice of a physician. 
 
 1067. One of the most important indications to be fulfilled 
 during teething is to diminish the local irritation arising from the 
 protruding tooth or teeth ; and this should be attended to as ear- 
 ly as may be, that as few constitutional symptoms may be pro- 
 voked as possible. 
 
 1068. For this purpose the gums should be carefully inspect- 
 ed ; and the portions of them in which teeth are due, or even 
 supposed to be due, should be well examined, that any change 
 in their colour or size may be detected, in order that the only 
 appropriate remedy may be applied in proper time. We have 
 laid down (Book I. p. 193) the order which nature usually pur- 
 sues in the performance of this process : therefore, a person ac- 
 quainted with this, will rarely fail to detect the point from which 
 the irritation proceeds. 
 
OF DENTITION. 327 
 
 1069. It must, however, be observed, that as far as our ob- 
 servations extend, the lower teeth, when they are the first, 
 (as they should be,) that make their appearance, rarely require 
 to be cut; whereas, the upper frequently do, whether they have 
 come at their regular period, or have anticipated the lower ones. 
 
 1070. If, upon the examination of the mouth, the gums are 
 found to be swollen and inflamed; the imprisoned tooth or teeth 
 should be set at liberty by cutting through them until the tooth 
 is felt. This operation becomes the more necessary, when the 
 local irritation has not been relieved by the natural means, 
 namely, by a salivation, or slavering, or by a diarrhoea ; and 
 especially so, when, instead of a copious discharge of saliva, 
 the mouth is found hot, dry, or clammy, and the bowels tardy. 
 Under such circumstances, no time should be lost ; the gums 
 should be amply incised, and the child liberally purged, or we 
 may expect some severe constitutional affection to follow; and 
 if the child have been habituated to liberal feeding, and that of 
 animal, or other stimulating food, it must be immediately with- 
 held, and be confined to the breast milk alone, if it be not 
 weaned ; and, if weaned, it should be allowed nothing but milk, 
 or milk and water sweetened. 
 
 1071. We are persuaded, were proper attention paid to the 
 child at this time, many of the evils arising from dentition would 
 be avoided ; but, unfortunately, the friendly admonitions of na- 
 ture are either neglected, or overlooked by the greater number 
 of parents. The efforts which nature makes at this time are all 
 calculated to prevent fever, or unnecessary local inflammation; 
 accordingly, a great quantity of saliva is poured from the mouth 
 by the irritated salivary glands, that the vessels of the part may 
 be unloaded ; the appetite of the child is diminished, that less 
 food may be taken ; and the general system is reduced by a 
 copious spontaneous diarrhoea. Thus, nature declares, in plain, 
 but emphatic language, what she requires to aid her; nor ought 
 she to speak in vain. 
 
 1072. To co-operate, then, with this beneficial intention, let 
 the child be put upon a mild and moderate diet, as just directed; 
 and on no account be permitted, either to eat or drink any thing 
 which has a tendency to stimulate the system. Let its bowels 
 
 .be carefully watched, that they may not become confined, or, if 
 
328 OF DENTITION. 
 
 they be so, let this condition be removed, by an appropriate diet, 
 or by gentle laxatives. 
 
 1073. We have found a liberal use of molasses, when there 
 was a tendency to constipation, of great service : this may be 
 employed in several ways, as may best suit the particular habits 
 of the child. If it be confined to the breast altogether, it will, 
 nevertheless, drink freely of this substance when mixed with 
 water. If it feed in part, its milk, or its milk and water may 
 be sweetened with it; or, if weaned, it may eat it on bread,- or 
 take it in any other practicable manner. 
 
 1074. Should the molasses not be sufficiently aperient, half an 
 ounce of flake manna maybe given in any victuals which may 
 require sweetening ; and, should this prove insufficient, a like 
 quantity may be given in a few hours more. But should the 
 symptoms of irritation not be relieved by this plan, a little calo- 
 mel may become necessary. 
 
 1075. But it must be evident, that little relief can be afforded 
 by any general applications, so long as the membranous expan- 
 sion over the tooth remains entire — therefore, nothing but a free 
 incision to the crown of the tooth can relieve the little sufferer. 
 And it is, often not less wonderful than delightful, to witness the 
 complete relief it affords. We have often observed excessive 
 fever, and a threatening irritation, subside almost instantane- 
 ously, after cutting the gums. 
 
 1076. Notwithstanding the decided advantages resulting from 
 cutting the gums, many are prejudiced against it; and will not, 
 but with great reluctance, permit their children to undergo the 
 operation, though they can cite no instance in which it has been 
 attended with any mischievous consequence. The objections to 
 cutting the gums, are, 1. That it is painful. Every body who 
 has performed this operation with a proper instrument, and that 
 in proper order, knows the contrary to this. In the first place, 
 the gum is not at any time a part of exquisite sensibility; and, 
 secondly, the speed with which the instrument passes through, 
 and the decided relief it almost invariably affords, at once pre- 
 vent any complaint on the part of the patient. This, however, 
 may be considered but negative proof: if so, we have sometimes 
 the most positive evidence that the operation cannot be painful, 
 in the children themselves asking for it to be performed. Our 
 
ON DENTITION. 329 
 
 own children have repeatedly solicited this kind office at our 
 hands. 
 
 1077. 2. It is said, it requires much judgment to perform this 
 operation; for if it be done too soon, it will afford no relief, be- 
 side making the tooth cut with more difficulty, by its leaving a 
 hard scar. As regards the degree of judgment necessary in this 
 case, we should think it very limited indeed, if, upon inspecting 
 the mouth, the person could not discover whether the gums 
 were, or were not, altered from their natural condition; if they 
 were, it is at once evident that the tooth is producing irritation 
 or inflammation, by its pressure against its coverings, and, there- 
 fore, they should be cut through. And though the tooth cut 
 upon may be yet remote from the surface, still the operation 
 maybe of the greatest possible advantage, by dividing the mem- 
 brane, now severely put upon the stretch, and from which the 
 whole irritation proceeds. When this membrane has been once 
 divided, it never unites again; and though the crown of the tooth 
 may not show itself for a long time, yet the irritation ceases, 
 and the disturbance of the system is quieted from the moment 
 the gum is divided. 
 
 1078. It is true, the gum will heal if the tooth be not very 
 near— but this is of no consequence; as its healing offers no in- 
 crease of difficulty to the passing tooth. Every body knows 
 that the second teeth are always more easily cut than the first; 
 yet these teeth have to pass through denser cicatrices than the 
 first; as by the drawing or falling out of the first teeth, much 
 larger wounds are made in the gums, consequently, larger scars 
 are left after their healing. 
 
 1079. And, if the gums be not changed, still the operation of 
 cutting may be highly advantageous, and should always be tried 
 in severe cases, as the irritation sometimes begins as soon as the 
 tooth itself begins to swell. We have many times had occasion 
 to prove the truth of this; therefore, the objection to cutting the 
 gums, lest the scars may do mischief, is without foundation. 
 
 1080. 3. Lancing the gums has been objected to, from a fear 
 that cutting on them may do injury to the teeth, by producing 
 caries, and thus be injurious to the set below. But this cannot 
 happen: — 1. Because if the lancet do touch the tooth, it can do 
 it no injury, as its hard enamel, which it possesses before the 
 tooth is about to be cut, will entirely protect it against such a 
 
 42 
 
330 ON DENTITIONS 
 
 consequence. 2. If it really did dispose the tooth so touched to 
 become carious, it would do no injury to the teeth which are to 
 succeed them, because they are not in contact with each other. 
 
 1081. The gums of such children as have not been lanced, 
 are more disposed to be ulcerated, than those gums which have 
 been cut. 
 
 1082. It may be well, however, to remark, that when this 
 operation is to be performed, it should be done with a bold hand 
 and a sharp instrument; for if the tooth producing the irritation 
 be not cut down to, so as to be distinctly felt by the lancet, the 
 operation will be of little avail. The mere bleeding of the gum 
 answers little or no purpose; and failing in the intention for 
 which it was proposed, only brings the operation into discredit, 
 besides prolonging the sufferings of the little patient. 
 
 1083. When the double teeth are about to be cut, they fre- 
 quently show themselves, by one point piercing the gum — over 
 the other portions of the tooth the gum remains, and is very 
 tender: so much so is this the case sometimes, that the child 
 will refuse every kind of food which may require chewing. In 
 such case the gum should be freely cut across, and thus liberate 
 the crown of the tooth. 
 
 1084. When a tooth which has been cut upon is remote from 
 the surface, or the absorption of the gum goes on tardily, it will 
 sometimes swell, and become very tender. When this is per- 
 ceived, it should again be cut; and this, repeatedly, as often as 
 new necessities may arise. 
 
 1085. The best mode of performing this operation, is by having 
 the child held, horizontally, with its head resting on the opera- 
 tor's knee — the hands of the child must be secured by the as- 
 sistant, and the lower jaw depressed and held firmly; while the 
 lancet is / introduced to that part of the mouth where the pained 
 gum is; the edge of the instrument is then made to traverse the 
 tooth, by an incision sufficiently deep to reach the tooth, which 
 must be so distinctly felt by the operator, as to satisfy him that 
 nothing is left interposing between his lancet and the tooth. If 
 the operation be properly performed, it gives no pain to the 
 child — on the contrary, we have known them to cease crying, 
 the instant the instrument penetrated the gum. 
 
OF CRUSTA LAOTEA, 331 
 
 CHAPTER XIII. 
 
 OF THE DISEASES ARISING FROM DENTITION. 
 
 1086. Though we have perfectly agreed with Drs. Cullen, 
 Struve, and others, that teething in itself is no disease, yet we 
 are aware that many affections of childhood are dependent upon 
 this operation, either for their existence or augmentation. It 
 would be unavailing, as well as injurious to the interests of so- 
 ciety, did we attempt to shut our eyes against truths no less im- 
 portant than palpable. We, therefore, fearlessly entitle certain 
 affections of the body at this period, " diseases of dentition." 
 We shall place the various complaints promiscuously, since they 
 observe no regular order ; nor is the same child liable to the 
 whole ; though we have occasionally seen two, three, or even 
 more united. As eruptions of various kinds are very frequent, 
 we shall commence our histories with an account of them. 
 
 Sect. I. — Of Eruptions* 
 
 1087. It is notorious to common observation, that a child, for 
 the first two years of its life, is especially liable to affections of 
 the skin. It is not our design to notice them all, or to enter 
 into any nosological arrangement of them — we merely intend, in 
 this place, to speak of such as appear evidently to be connected, 
 in some way or other, with dentition. We shall, therefore, first, 
 notice, 
 
 A — The Crusta Lactea, or the Milky Scall. 
 
 1088. Dr. Good* supposes that this disease has acquired its 
 name from the " milky, or rather the creamy appearance and 
 consistency of the discharge." But as we have never witnessed 
 this " creamy appearance," to justify the name, we should rather 
 
 * Study of Medicine, Vol. IV. p. 422. 
 
332 OF CRUST A LACTEA. 
 
 suppose it has been given to it, from the circumstance of its ge- 
 nerally appearing during lactation. At all events, it is a disease, 
 we believe, exclusively belonging to infancy."* 
 
 1089. This complaint begins sometimes sooner, and at other 
 times later, as the disposition of the system to protrude the teeth 
 may exist ; for we never remember to have seen it before den- 
 tition had commenced, nor after it was completed. 
 
 1090. It usually begins upon the cheek, or near the centre of 
 the forehead; it first shows itself by an assemblage of small 
 whitish pustules upon a very red surface : these gradually change 
 to yellow, and brown, which presently break, and form a scab 
 of greater or less density, from which proceeds an ichorous dis- 
 charge. New pustules soon appear, which, after having under- 
 gone the change just spoken of, unite, as it were, with the for- 
 mer, and thus gradually travel to various parts of the body; but 
 the face, scalp, and neck, are particularly liable to it. We 
 have seen it cover nearly every part of the cuticular system. 
 When it is even very general over the face, it is a little remark- 
 able, that it never attacks either the nose, or the eyelids. 
 
 1091. There is a considerable variety in the intensity of this 
 disease; it sometimes confines itself to very narrow limits; at 
 others, it will be very extensive. We have seen it occupy the 
 cheeks alone; at other times the forehead; but more frequently 
 both. Sometimes the discharge is very acrid and profuse, leaving 
 the surface of the skin both red and excoriated; at other times, 
 the quantity discharged is small and mild, leaving the surface 
 covered with a brownish dry scab. 
 
 1092. When the scab drops off, and does not reappear, the 
 cuticle is found tender, red, a little elevated^ and marked by 
 'fissures — this pellicle exfoliates, perhaps, several times. It is 
 said, the skin never cracks into deep fissures, as after some 
 other eruptions. 
 
 1093. This complaint is generally considered more trouble- 
 some than dangerous; yet we have seen two instances of death, 
 evidently from this disease. In these cases, the itching was un- 
 ceasing, during the day and night ; the children were worn down 
 
 * We are well acquainted with a family of five children, who have all, in suc- 
 cession, had this complaint. It sometimes begins as early as the sixth month, and 
 continues for twelve months, or even longer. We believe no attempt was made 
 to relieve this formidable eruption in these cases. 
 
OP CRUSTA LACTEA. 333 
 
 from the want of rest, as well as exhausted from the excess of 
 discharge. The eruption covered the whole body, and conti- 
 nued without amendment for many months, until the children 
 were destroyed by the pertinacity of fever, and the profuseness 
 of diarrhoea. 
 
 1094. Some, indeed, believe it only dangerous when its pro- 
 gress, or duration, is interfered with; and, therefore, deprecate 
 every attempt at cure. We are, however, very far from this 
 opinion, because we believe it to be founded in error. They 
 ask, " Why should we meddle with a complaint which is evi- 
 dently an effort of nature to get clear of a greater evil? More- 
 over, it is never a dangerous disease ; nor does it ever leave un- 
 seemly marks; and if attempted to be dried up, will certainly 
 prove injurious to the child." 
 
 1095. We shall take the liberty of making a few remarks 
 upon each of these positions. What evidence is there of this 
 being^ a critical eruption, any more than convulsions are criti- 
 cal spasms, or that fever is an effort of nature to get clear of 
 some noxious agent? Yet who, without an effort to control 
 convulsions, will see a child expire, because they are produced 
 by teething ? — or who will look on, and see it consumed by fe- 
 ver, without attempting to afford relief, because it arises from 
 the irritation of protruding teeth? 
 
 1096. As to its never being a dangerous disease, we have just 
 stated that we have seen two instances of death from crusta 
 lactea : but, suppose it were not dangerous — are we to suffer a 
 poor child to bear with a loathsome and troublesome disease, 
 without any attempt to remove it, because the disease will not, 
 perhaps, terminate in death? Why should any of the non-fatal 
 diseases of infancy be meddled with, since they will not kill, 
 however troublesome they may be, or however interminable 
 may be their duration ? 
 
 1097. And because it takes its departure from the body after 
 a troublesome visitation of many months, and leaves no unseem- 
 ly scars, the poor infant is to be left to contend with affliction, 
 and bear with its ravages, the whole of that period, merely be- 
 cause it will not leave its mark behind ! 
 
 1098. It is asserted, when an attempt is made to cure this 
 complaint, and we succeed in drying it up, that it has always 
 proved decidedly injurious to the child. 
 
334 OF CRUSTA LACTEA. 
 
 1099. As this is a broad assertion, and one that is confident- 
 ly believed by many, it will be well to examine into its truth, 
 when a cure is attempted under proper circumstances. 
 
 1100. We will first inquire into the nature of the eruption. 
 The skin, like every other organ of the body, has predisposi- 
 tions to disease, peculiar to its structure. These predisposi- 
 tions may, however, lay dormant for many years, or for ever, 
 if the appropriate exciting cause be not applied, to call them 
 into a state of actual disease. Before they are awakened into 
 a palpable form, the system suffers neither inconvenience nor 
 injury from this mere disposition to disease ; but as soon as any 
 circumstance shall convert this disposition into morbid action, 
 the part thus acted upon will suffer, in a degree, proportionate 
 to the extent and nature of this provoked disease. Therefore, 
 in the case under consideration, the cutting of the teeth rouses 
 the latent disposition into action ; and the skin is now made to 
 suffer under an active disease. 
 
 1101. This being certain, we must now inquire, is the erup- 
 tion in question a consequence of a critical effort of the system 
 to relieve some other portion of the body of an existing dis- 
 ease ? — or, is it a mere consequence of some specific irritation? 
 If the first part of this question be answered in the affirmative, 
 it must then be shown that it has ever fulfilled the intention for" 
 which it was instituted. Can this be shown? We believe it 
 cannot; for the local irritation in the mouth continues without 
 abatement, however copious this eruption may be; it would, 
 therefore, appear it was not intended to remove, or even to di- 
 minish the consequences arising from the protrusion of the teeth 
 through the gums, or, if it were, it fails in the object ; there- 
 fore, it must be contingent and not critical. 
 
 1102. But it may be said they are cause and effect, and in 
 this relation they must be considered. Let this be admitted — 
 their connexion will then stand thus: there is 'a disposition in 
 the skin to crusta lactea, but this disposition requires some ex- 
 citing cause to bring it into Action : and this exciting cause is 
 the irritation of teething ; hence, this disease only appears during 
 infancy, and even then rarely. 
 
 1103. But would it not seem extraordinary, that so loathsome 
 and obstinate a disease as the one in question, should be insti- 
 
OF CRUSTA LACTEA. 335 
 
 tuted to relieve one of infinitely a. milder grade? If this dis- 
 ease were a constant attendant upon teething, and teething were 
 found to be less severe, and less hazardous, by its appearance, 
 there might be some reason for inviting its presence, or foster- 
 ing its continuance on the surface of the body ; we, therefore, 
 conclude, that, however intimately some affections, at the pe- 
 riod of teething, may be connected with this process, the one 
 we are now considering must not be ranked among the number.. 
 
 1104. The next question is, will the child suffer by the de- 
 struction of the crusta lactea? We unhesitatingly say, No; 
 provided this be attempted in proper time, and in a proper 
 manner — at least, this is the conclusion to which our own expe- 
 rience would lead us. If children have suffered from attempts 
 to cure this loathsome eruption, the injury was altogether of an 
 artificial kind ; and made to arise from employing remedies for 
 suddenly extinguishing the disease, after the system had become 
 habituated to the waste from its surface. In attempts of this 
 kind, we can readily believe injury might be sustained; but this 
 does not prove the critical nature of the disease in question; it 
 only goes to show, that when a drain of this, or any other kind 
 is established, it must not be suddenly suppressed. 
 
 1105. We see this well illustrated in ulcers of every kind, 
 which are of long standing ; but is there any one who would 
 have hesitated to heal the fresh wounds, from which these sores 
 originated ? We think not — yet no one of real experience, 
 would do this after they had become confirmed drains, without 
 first establishing some compensating change in another part of 
 the body; or so gradually have encroached upon the daily waste, 
 as not to be perceived by the system. This is precisely the 
 case with crusta lactea. 
 
 1 106. For these reasons, we do not hesitate to attempt the re- 
 lief of crusta lactea; especially when we see it early, (that is, 
 when it is confined to the cheeks and forehead of the child,) and 
 that by the most prompt remedies. We direct the diminution 
 of nourishment of every kind, and never permit any in which 
 animal food enters. If the child be still at the breast, we request 
 it to be nursed less frequently; and, sometimes, even confine the 
 mother, or nurse, to a strictly milk and vegetable diet. If it be 
 weaned, we forbid every stimulating article, and direct a reduc- 
 
336 OF CRUSTA LACTEA. 
 
 lion of its milk ; confining it to thin arrow-root, with very little 
 milk, or to the rennet whey. 
 
 1107. At the same time, we order small doses of sulphur, or 
 sulphur and magnesia, to be given so frequently, and in such 
 quantities, as shall keep the bowels loose, but not severely 
 purged. After persevering in this plan for a week, we almost 
 always find an abatement of redness at the margins of the 
 scabs, and diminution of the itching. 
 
 1108. After having purged the bowels with sulphur, or sul- 
 phur and magnesia for a few days, as above directed, we then 
 commence with small doses of calomel; as follows — 
 
 R. Calom. pp. gr. x. 
 
 Creta. pp. 3j. M. div. in xx. par. 
 
 1109. One of these powders is directed to be given every 
 morning and evening in a little molasses or sirup of any kind. 
 Should they prove too purgative, from half a drop to a drop of 
 laudanum is added to each dose. Should they not move the 
 bowels sufficiently, an additional powder is ordered. 
 
 1110. We pursue this plan for at least a fortnight, before we 
 make any local application; and, indeed, we do not apply them 
 then, unless there be an abatement of the inflammation, and itch- 
 ing as above remarked. But should both these have happened, 
 we commence with the calomel ointment ;* but confine its ap- 
 plication to some one spot of diseased surface. When this be- 
 comes relieved, w T e select a second, and so on until all are re- 
 lieved. But let it be remembered that the calomel powders are 
 continued through the whole course of the disease, and even for 
 some time after, if the disease has been extensive and obstinate. 
 
 1111. When this plan is duly persevered in, it rarely fails to 
 succeed ; nor have we ever seen a. single instance in which any 
 untoward symptoms have arisen. We have sometimes substi- 
 tuted the citron ointment, reduced one-half, for the calomel oint- 
 ment, when the latter seemed to have lost its effect. When the 
 discharge is considerably diminished, and nothing appears to re- 
 main but the dry scabs, we almost always employ the tar oint* 
 
 * £. Calom. ppt. g\'y 
 
 Cerate Simp. 5J. 
 
 Ess. Lemon. gut. xx. M. 
 
OF CRUSTA LACTEA. 337 
 
 ment instead of either of those just mentioned — this may be ap- 
 plied twice a day. 
 
 1112. The citron, as well as the tar ointment, must be had re- 
 course, to, as above directed, should that of the calomel not prove 
 sufficient. Indeed, we believe it would always be best to finish 
 with the tar ointment; as it seems to have a peculiar facility in 
 removing the scabs, and allaying the itching, which last, by the 
 by, is one of the most troublesome attendants upon the disease. 
 
 1113. Where the warm bath* can be had recourse to with 
 convenience, it should be used two or three times a week, as it 
 greatly promotes the efficacy of the other remedies ; and, during 
 the whole period of the attempt at cure, and, especially, in the 
 beginning, when the discharge is both copious and acrid, the sur- 
 rounding parts should be washed with a mild solution of fine soap, 
 even three or four times a day. We have thought we have de- 
 rived advantage, where the discharge is free, from rubbing, or 
 smearing the sound skin immediately surrounding the sores, af- 
 ter washing, with a little fresh hog's lard and bees'-wax melted 
 together, to defend these parts against excoriation. 
 
 1114. This complaint is sometimes treacherous: after giving 
 promise of a speedy departure, it will suddenly return, with re- 
 newed force. Dr. Strackt has recommended the decoction of 
 the viola tricoler, Lin., or heart's ease, as a specific in this dis- 
 ease; but of this we can say nothing from our own experience. 
 It might, however, in obstinate cases, be tried in conjunction with 
 the remedies recommended above. He directs a handful of the 
 fresh plant, or half a dram of 'the dried leaves to be boiled in 
 half a pint of cow's milk, and this quantity given morning and 
 evening. He affirms that for the first week, it greatly aggra- 
 vates the complaint ; but at the same time the urine acquires the 
 odour of the urine of cats ; and at the end of a fortnight the 
 cruets begin to fall off, and the skin underneath appears clean. 
 But when the usual smell of urine remains, the disease will ge- 
 nerally be of long continuance. Prof. Selle, however, has af- 
 firmed that this plant is either noxious or inert.:}: We have 
 
 • 
 
 * We think that much advantage has been derived, by substituting a pretty 
 
 strong infusion of flaxseed, for the plain warm water, 
 f Bateman's Synopsis, p. 153. 
 
 * Bateman's Synopsis. Ibid. 
 
 43 
 
338 OF TOOTH RASH. 
 
 never perceived the smell spoken of by Dr. Strack. It may, 
 however, be proper to observe, that in all our endeavours to re- 
 lieve this complaint, as directed above, we have never witnessed 
 any injury to arise from the attempt.* 
 
 B — Tooth Rashes* 
 
 1115. Nothing declares the intimate connexion, or play of 
 sympathies between the gums and skin during dentition, more 
 than the number of eruptions to which it becomes liable at that 
 period. Authors, (Underwood, Bateman, &c.) have described, 
 and we have seen five or six different affections of the skin 
 during the cutting of the teeth, all of which appear perfectly 
 harmless, unlessimproperly treated, But as there are diseases 
 of the system of a dangerous kind, which are accompanied with 
 efflorescences, or pimples, much alarm is excited when any 
 eruptions of analogous appearance show themselves upon the 
 
 .surface. On this account, it may be well to give a short account 
 of them. For this purpose, we shall employ the descriptions of Dr. 
 Willan, as they appear to us to be perfectly well marked. 
 
 1. Strophulus Confertus, or Tooth Rash, 
 
 1116. " Is an eruption of numerous papillae, varying in their 
 size, and appears on different parts of the body in infants, during 
 dentition, and has thence been denominated the tooth rash. It 
 is also termed, sometimes, the rank red gums." 
 
 * We have had lately, (January, 1828,) a very severe and interesting case of 
 the crusta lactea in a child of sixteen months old. It commenced when the child 
 was eight months old in the common way, and spread gradually over the whole 
 face, scalp, neck, bddy, and limbs. The child was feverish, restless, and almost 
 constantly scratching, both day and night. A variety of remedies were tried be- 
 fore we saw it, without the slightest benefit. We commenced the cure by purges 
 of sulphur- and magnesia; confined the child to a diet of vegetable mucilages, as 
 gum Arabic, tapioca, sago, rice jelly, &c. Ordered a warm flaxseed tea bath 
 every other day. After a fortnight's use of the sulphur and magnesia, the calo- 
 mel, as directed above, was given, together with a pretty strong infusion of the 
 dulcamara. The sores w^re washed with the same infusion. After a perse- 
 verance in this plan for two months, an evident amendment was perceived in the 
 nature and extent of the eruption. At this time we vaccinated the child: and 
 this disease ran a regular and satisfactory course. After the vaccine scab dropped 
 off, the sores healed very rapidly, by the use of the tar ointment. In the course of 
 another month, the child was perfectly well, and remains so to this time, (May, 
 1831.) 
 
OF THE RED GUM. 339 
 
 1117. •' About the fourth or fifth month after birth, an erup- 
 tion of this kind takes place, in most infants, on the cheeks and 
 sides of the nose, extending sometimes to the forehead and arms; 
 at other times, though less frequently, to the trunk of the body." 
 
 1118. This affection differs a little from the red gum, by being 
 less vivid in their appearance, the pimples smaller, and more 
 ■crowded together. We have repeatedly known this species ap- 
 pear much later than is fixed by Dr. Willan ; and their produc- 
 tion seems evidently connected with the process of dentition; for 
 when the process is retarded, this appearance is retarded : there- 
 fore, the time at which they show themselves may be better 
 fixed by saying, that when detention begins, they commence. 
 Every child, however, is not subject to it. It is rarely attended 
 by constitutional symptoms, and consequently, requires but little 
 medical care. This complaint is usually of about a fortnight's 
 continuance. 
 
 1119. We, however, almost always think it best, should there 
 be any disturbance in the bowels, to give a pretty full dose of 
 magnesia ; to keep the skin clean and soft by washing with warm 
 water, and to remove any irritating substance from the surface 
 that is covered with the eruption, such as flannel or muslin, and 
 substitute linen. When this is attended to, we think the course 
 of the disease is shortened ; for the pimples soon after are ob- 
 served to fade, and cast off their little shells, and, finally dis- 
 appear. A decided advantage is obtained, we think, by rubbing 
 the part with a little dry flour after washing, when it becomes 
 perfectly dry. 
 
 2. Strophulus Interlinclus, or Red Gurn* 
 
 1120. This complaint is confined to early infancy, and espe- 
 cially to " the mouth," as it is called. Very few children escape 
 this complaint ; and most nurses are fond of seeing it — so much 
 so, indeed, and so inevitable and useful do they consider its pre- 
 sence, that should any indisposition befall the child, and this 
 eruption not have possession of the skin, it is at once attributed 
 to the absence of the gum. With a view, then, to invite its ap- 
 pearance, the child is kept unusually warm, and some stimulating 
 tea is given it, such as of sweet marjoram, saffron, catmint, &c, 
 and after having been thus disciplined for a longer or a shorter 
 
340 OF THE RED GUM. 
 
 period, the poor child is but too frequently loaded with a heavy 
 crop of " Red Gum." 
 
 1121. This eruption, however, seems connected, in some way 
 or other, with a derangement of the stomach and bowels. This 
 derangement may proceed, 1st, from the meconium not having 
 been well purged off, or its being of an unusually acrid quality; 
 2dly, it may proceed from an acid state of the stomach, owing 
 to feeding the child with improper food ; or to its being made to 
 receive too great a quantity of it; to some ill quality in the mo- 
 therms milk, or a constitutional feebleness of stomach. Hence, 
 this complaint is commonly ushered in by nausea, vomiting, or 
 diarrhoea ; 3dly, to the child being kept too warmly clad, or too 
 Warmly covered, especially its head, by which means it is obliged 
 to breathe over and over again the same air ; and is also thrown 
 into a profuse perspiration. We have elsewhere noticed this in- 
 jurious practice. (Book I. 135, par. 445.) 
 
 1122. This disease, for the most part, is rather provoked, than 
 spontaneous ; for children who are kept in a moderate tempera- 
 ture and who are dependent upon the breast for support, rarely 
 have this disease, especially if the bowels have been well purged 
 of the meconium, atid the child naturally of a good constitution. 
 
 1123. "The red gum or gown, occurs chiefly within the first 
 two months after birth, and is characterized by papulae of a vivid 
 red colour, situated most commonly on the cheeks, fore-arms, and 
 backs of the hands, but sometimes universally diffused. They 
 are usually distinct from each other; but are mixed with red dots, 
 or stigmata, and often with larger red patches, which have no 
 elevation. Occasionally, a few small vesicles appear on the 
 hands and feet ; but these soon desiccate without breaking."* 
 
 1124. This disease, under ordinary circumstances, requires 
 little or no medical treatment. It is, nevertheless, proper that 
 due attention be paid to cleanliness, by daily washing with warm 
 water ; and, also, if errors have been committed in either of the 
 ways mentioned above, they should be immediately rectified. 
 The bowels should be gently opened by small doses of calcined 
 magnesia; and, if pain attend, a half or whole drop of laudanum 
 may be given. The cold bath, improperly used, or even a strong 
 current of cold air, may do mischief at this time. And, should 
 
 * Bateman. 
 
OF THE WHITE GUM. 341 
 
 this eruption be repelled from the skin, alarming symptoms may 
 immediately ensue ; such as great oppression and difficulty of 
 breathing, drowsiness, or incessant crying, and spasmodic twitch- 
 ings. The whole surface of the body is now pale ; the pimples 
 have all disappeared ; the child becomes blue around the mouth; 
 it refuses the breast ; and stretches itself out stiff its "whole length, 
 and then becomes suddenly relaxed ; cold skin, &c. 
 
 1 125. The best remedy, under such circumstances, is the warm 
 bath, in which the child should be immediately placed, and kept 
 until its skin acquire warmth ; it should then be well dried, and 
 wrapped up in warm flannel — at the same time some pretty 
 strong sweet marjoram tea should be given, or any other mild 
 stimulant of the kind. Dr. Underwood recommends two or three 
 drops, three or four times a day, of the compound spirit of am- 
 monia, and a blister between the shoulders. We have never 
 seen either of these necessary. 
 
 3. Strophulus Albidus, or White Gum. 
 
 1126. "This eruption consists of numerous, minute, hard 
 whitish specks, a little elevated, and surrounded by very slight 
 redness. These specks, or papulas, when their tops are removed, 
 do not discharge any fluid; they appear chiefly on the face, neck, 
 and breast, and continue a long time." 
 
 1127. This affection rarely requires any medical treatment, 
 unless it have been driven from the surface by a current of cold 
 air, or the application of cold water. It is rarely ever attended 
 with any constitutional irritation, and therefore, while it pre- 
 serves its mild form, deserves but little notice. But should mis- 
 management, or any other cause, have driven it suddenly from 
 the surface, it may, like the red gum, {strophulus intertinctus, 
 which see,) be productive of inconvenience, or even of danger, 
 and must, when this happens, be treated like that affection when 
 it has been repelled. It is, however, proper in the species un- 
 der consideration, that due attention should be paid to keep the 
 skin free from all impurities, by washing with warm water. 
 
 1128. Dr. Willan describes a variety of this complaint, which 
 sometimes becomes very troublesome, though never dangerous. 
 He declares it to be both painful and obstinate, yet requires no 
 particular treatment, except that which is proper in all these 
 
342 OF STROPHULUS CAND1DUS. 
 
 affections; namely, cleanliness. We do not remember ever to 
 have seen this variety as described by both him and Bateman. 
 
 4. Strophulus Volaticus. 
 
 1 129. "This variety is characterized by small circular patches 
 or clusters, of papulae, which appear successively on different 
 parts of the body. The number of papulae in each cluster is from 
 three to twelve ; both the papulae and their interstices are of a 
 high red colour. These patches continue red, with a little heat 
 and itching for about four days, when they turn brown, and be- 
 gin to exfoliate. The eruption is, in many cases, limited to two 
 or three patches on the arms or cheeks. In some instances, how- 
 ever,. one patch declines, another appears at a small distance from 
 it, and in this manner the complaint spreads gradually over the 
 face, body, and Jimbs, not terminating in less than three or four 
 weeks. During this time the child has usually a quick pulse, 
 and a white tongue, and is uneasy and fretful." 
 
 1130. We have several times seen this complaint; but it has 
 always, so far as we can recollect, appeared later than is usually 
 described, or not until the child be about to cut the jaw teeth, or 
 little molars. , We have found it occasionally very troublesome ; 
 and sometimes to require a treatment similar to crusta lactea, of 
 which, in this situation, it has been considered, by some, as a 
 variety. 
 
 1131. As this complaint is usually attended by some derange- 
 ment of the system, and particularly the bowels, attention should 
 be paid to them. They must be treated agreeably to the state of 
 the system; if fever attend, the diet should be diminished, if it 
 be only milk — no animal food should be permitted in any form. 
 The bowels should be purged with magnesia; and the calomel and 
 ointments used, as directed for crusta lactea. (1107.) Should diar- 
 rhoea attend, it must be managed as directed for that complaint. 
 
 5. Strophulus Candidus. 
 
 1132. u In this form of strophulus, the papulae are larger than 
 in the foregoing species. They have no inflammation around 
 their base, and their surface is very smooth and shining, so that 
 they appear to be of a lighter colour than the adjoining cuticle* 
 
SORE EARS. 343 
 
 They are diffused at a considerable distance from teach other, 
 over the loins, shoulders, and upper part of the arms : I have not 
 observed them in any other situation." 
 
 1133. "This eruption affects infants above a year old, in the 
 latter periods of dentition:, it likewise occurs during the state of 
 convalescence after fevers, and inflammation of the bowels and 
 lungs. The papules continue hard and elevated for about a week, 
 then gradually subside and disappear." 
 
 1134. This affection requires no medical treatment — the whole 
 attention must be paid to the state of the gums. 
 
 Sore Ears, 
 
 1135. Children, during dentition, very frequently have slight 
 pustules form behind the ears, which soon become ulcerous: or 
 look, oftentimes, like a superficial excoriation. This condition of 
 the ears also takes place, before any suspicion of teeth being the 
 cause can be entertained, especially in very lusty children. 
 
 1136. There are few eruptions which attack an infant more 
 decidedly cherished than that producing sore ears; hence, what 
 was but in appearance a very slight excoriation in the beginnings 
 and which might readily have been healed by proper and fre- 
 quent washing with warm milk and water, or fine soap and wa- 
 ter, is permitted to degenerate into a painful, tedious, and often- 
 times offensive ulcer : as its first appearance was welcomed, so is 
 its continuance perpetuated, by various stimulating things, under 
 the specious pretext of its being an important drain for the nox- 
 ious humours of the body. 
 
 1137. The sores being thus encouraged, eventually discharge 
 a large quantity of both pus and serum : in a word, they are con- 
 verted into " issues," which it is declared, on all hands, it will 
 not do to dry up. This- popular prejudice perpetuates an evil, 
 which should never have been permitted to have existed — for a 
 sore is an evil, be it placed where it may, unless it be distinctly 
 critical, which we deny this to be. The reasoning we em- 
 ployed when speaking of the crusta lactea, will strictly apply 
 here; and the motives which led us to the use of remedies in that 
 complaint, would influence in this — therefore, we never hesitate 
 a moment to set about so desirable an end, nor have we ever 
 witnessed, when properly managed, the. slightest inconvenience 
 
344 SORE EARS. 
 
 to follow the practice. Dr. Good says, " The discharge is often 
 peculiarly offensive ;" " it cannot be checked too soon ; for if it 
 continue for a few weeks, or, perhaps, even less, it may acquire 
 a habit, the suppression of which may run the risk of superin- 
 ducing some worse disease than itself, as dyspepsia, diarrhoea, or 
 convulsions."* 
 
 1138. We commence the treatment of this affection bv regu- 
 lating the diet of the child, if this be necessary — that is, if it be 
 in the habit of using animal food in any form, we forbid its far- 
 ther employment, and confine it to vegetables and milk ; as rice, 
 arrow-root, or sago: either of which can be taken with milk, or 
 with a little sugar, without the milk. 
 
 1139. The bowels must also be purged with small doses of ca- 
 lomel ; that is, a grain or half a grain every morning and evening, 
 as the child may be older or younger, or it may affect the bowels. 
 The sores themselves must be kept perfectly clean by frequent 
 washing with soap and water, or milk and water. During this 
 time it would be well for the child to do without a cap, as it 
 keeps the parts too warm, as well as sticks to the sores when in 
 contact with them. Should the child be in the habit of scratch- 
 ing the parts, mufflers should be put upon its hands. A piece of 
 fine rag spread with simple cerate ; that is, a cerate composed of 
 a little bees'-wax and sweet oil melted together ; or, what is bet- 
 ter, fresh hog's lard, instead of the sweet oil. When the child 
 is placed for sleep, let it lie as much as possible upon its back, 
 that the sore need not be kept too warm. 
 
 1140. Should the sores be very much inflamed, and very irri- 
 table, a soft poultice of bread and milk should be applied, con- 
 fined in fine linen rags, every four or five hours, until these 
 symptoms be abated. The poulticing should not be continued 
 longer than to subdue the inflammation ; for, if it be, it invites a 
 great many little pustular bodies, even on the margin of the 
 sound skin, which break, and increase the sore surface. There- 
 fore the instant this is observed, the poultice should be laid aside. 
 
 1141. After preparing the body, as well as the parts in this 
 manner, which may occupy a week, or even more, according to 
 the extent of surface involved, the length of time the disease has 
 continued, and the degree of inflammation present, we may com- 
 
 * Study of Med. Am. Ed. Vol. 2d. p. 211. 
 
OF TONGUE-TIE. 345 
 
 mence with the calomel ointment, (1 110.) This must be smeared 
 upon the external margins of the sores, as well as upon the sound 
 skin itself, twice a day, taking care to wash the parts, as before 
 directed, before each application of the ointment, and gradually 
 encroaching upon the sores every day, by a more extensive ap- 
 plication of the ointment. This remedy will rarely fail to de- 
 stroy the farther disposition to ulceration, and pretty quickly al- 
 ter the action of the parts, so as to make them discharge a healthy 
 pus, instead of the ichor and sanies to which they have been so 
 long accustomed. 
 
 1142. When the parts have become healed, but covered with 
 a scab, and especially if this be attended with itching, the tar. 
 ointment should be immediately substituted. 
 
 CHAPTER XIV. 
 
 OF TONGUE-TIE. 
 
 1 143. So far as we recollect, we have not met with any writer 
 who has distinguished between the accidental fetter which is oc- 
 casionally imposed upon the fraenum of the tongue, and the ori- 
 ginal conformation of the fraenum, which renders the tongue too 
 short ; but this difference should be carefully noted, as very se- 
 rious consequences may result from mistaking one for the other, 
 We shall, therefore, notice both these conditions of the fraenum 
 of the tongue. 
 
 1 . Of the adventitious tying of the Tongue. 
 
 1144. Very frequently there is attached to the fraenum of the 
 tongues of new-born children, a nearly transparent, whitish mem- 
 brane, which pursues the natural fraenum through its whole 
 course, continues beyond the point where the fraenum stops, and 
 terminates near the extremity of the tongue itself; so that the 
 tongue is tied down, as it were, to its proper bed. 
 
 ] 145. In consequence of this disposition of the fraenum, the 
 child cannot elevate the tongue or protrude it beyond the lips : 
 
 44 
 
346 OK TONGUE-TIE. 
 
 and in its attempts to suck, it cannot apply it with sufficient force 
 or certainty to the nipple, to make a complete exhaustion; there- 
 fore, it can suck but imperfectly; and this is accompanied by 
 a clucking kind of noise. Whenever this is observed, the 
 mouth should be examined, and it will almost always be found 
 in the situation just described ; but not necessarily, as there may 
 be clucking without this membrane; but this membrane, w T e be- 
 lieve, is never without the clucking. 
 
 1146. This membrane is easily discovered by provoking the 
 child to cry, or by elevating the point of the tongue by the ex- 
 tremity of the little finger. In making the attempt to raise the 
 tongue the child is almost sure to cry; and then this mem- 
 brane is readily discovered, as it is now fully upon the stretch. 
 
 1147. This defect is easily remedied. It should be done in 
 the following manner: Let the child be laid across the lap of 
 the nurse, with its face towards a proper light, and the operator 
 stand behind the head, so that he does not intercept the light. 
 The chin of the child must be gently depressed by the forefin- 
 ger of the nurse. When the chin is thus depressed, the little 
 finger of the left hand of the operator, must be insinuated be- 
 tween the side of the tongue near its tip, and the inner cor- 
 responding portion of the jaw until it can lift up the point 
 of the tongue; which being done, the membrane is imme- 
 diately brought into view, and upon the stretch ; or, should the 
 child now begin to cry, as it almost always does, the operator 
 can easily place his finger under the tongue, and keep this false 
 frsenum tense, while, by a single stroke directly across it by a 
 sharp gum lancet, he divides it to the true frsenum: the opera- 
 tion is then finished. We have never known it necessary to 
 repeat this operation. The incision through the membrane, 
 never yields more than a small drop of blood; no hemorrhage 
 can ensue, as this tissue is but very slightly vascular. 
 
 2. Original Conformation of the Frcenum, rendering the Tongue 
 
 too Short. 
 
 1148. In this species of "tongue-tie," the difficulty to the 
 child's sucking, accompanied by the clucking noise just men- 
 tioned, arises from the fraenum proper, being unusually fleshy, 
 and carried too far towards the extremity of the tongue ; so that 
 
OF SWALLOWING THE TONGUE. 347 
 
 there is but a small portion, or distance from the insertion of the 
 fraenum, and the outer extremity, or tip of this organ. 
 
 1149. In this case, the inconveniences to the child are pre- 
 cisely of the same kind as in the other ; but not, so far as we 
 have observed, to the same extent : indeed, we have occasionally 
 seen both combined. When the fraenum proper is thus con- 
 formed, we never venture to do anything; 1st, because we have 
 never found it absolutely necessary ; as it never so far interferes 
 with sucking as to prevent it — the clucking noise, and the dis- 
 play of a little temper on the part of the child, in not receiving 
 its nourishment as fast as it desires, are the only inconveniences 
 attending it; 2dly, because, it is extremely doubtful whether the 
 operation has ever been useful ; but it is certain, that it has 
 often been troublesome, sometimes dangerous, and occasionally 
 fatal. Bleeding to a fatal extent, swallowing the tongue, and 
 convulsions, have followed the operation; we, therefore, with 
 our present views, can never recommend it. 
 
 3. Swallozvi?ig of the Tongue, and Hemorrhage. 
 
 1 150. We have often heard of, but we never have seen a case 
 of either swallowing the tongue, or of hemorrhage, from cutting 
 it. Dr. Underwood speaks doubtfully upon this subject: he 
 says, " The occasion of this accident, it hasbeen said, is cutting 
 too deep in dividing the fraenum. I have here to notice its 
 symptoms, and remedy. The former are those usually at- 
 tending strangulation, and come on suddenly, and without any 
 probable cause, but that df the tongue being cut; but to which 
 they are seldom attributed by those who are strangers to the 
 complaint. The infant appears greatly agitated ; the face turns 
 black ; and, unless these symptoms soon disappear, the child 
 goes off in a convulsion. But if they are presently removed, 
 the infant is as suddenly well; though they generally return 
 again, and have, in several instances, proved fatal. 
 
 1151. " Mons. Petit, (Mem. de l'Acad. des Sciences,) has, per- 
 haps, the credit of discovering the true cause of the complaint. 
 The remedy consists in nothing more than bringing the tongue 
 into its proper place, and if the infant be suckled, putting it im- 
 mediately to the breast, will give the tongue its natural direction. 
 Should the child be brought up by hand, the tongue should be 
 watched for some time, at least until the bleeding be stopped; 
 
348 OF SWALLOWING THE TONGUE. 
 
 the complaint taking place only in consequence of that being 
 considerable, so as to become an inducement to the infant to 
 continue sucking at the part." 
 
 ] 152. " When the sublingual veins are actually wounded, the 
 danger, it has been said, is considerable; and it is to M. Petit, 
 that we are again indebted for the best contrivance for sup- 
 pressing this hemorrhage. The means consist only of a piece 
 of ivory, in the form of a short fork ; the prongs of which should 
 be so placed as to press against the apertures in the veins, and 
 the other end against the inside of the lower jaw, and should, 
 therefore, be broad, and somewhat convex, that it may keep its 
 place." 
 
 1153. We are sorry we cannot give any thing more satisfac- 
 tory upon this subject, than what we have just detailed. Jf it 
 be true, as Dr. Underwood asserts, that swallowing the tongue 
 arises only from too much blood flowing after cutting it, it must 
 be of very rare occurrence. In this country, we have never 
 heard of an accident from cutting the tongue ; and w 7 e are sure 
 that none can follow, if the case be a proper one for this opera- 
 tion, or, if it be properly performed. 
 
 1154. It strikes us, there must be something very reprehen- 
 sible, when hemorrhage to any extent occurs, either in the mode 
 of operating, or in selecting the case for it. It is generally re- 
 commended to employ scissors for this purpose ; to these we 
 have objected for many years. We never employed them but 
 once, and then found them so extremely inconvenient, that-we 
 determined to use them no more. W 7 e substituted the common 
 gum lancet, as directed above ; and we have every reason to 
 be satisfied with it for this purpose. We have already pointed 
 out the kind of cases we judge proper for this operation; in 
 such no accident can occur, unless the most perfect mal-adroit- 
 ness accompany the operation. 
 
 1155. We have said, we have never seen a case of swallow- 
 ing the tongue; that is, we were never present to observe the 
 phenomena such an accident would present — but we were 
 called to see a child who was in the habit of doing this; it was, 
 however, relieved before we arrived. The nurse informed us, 
 the child in question would swallow it several times a day, if 
 not watched. She always relieved it by the handle of a tea- 
 spoon pressed against the tongue, and drawing it forward. This 
 child, we know, never had had any thing done to its tongue- 
 
OF BLEEDING FROM THE NAVEL-STRING, 349 
 
 1156. In case of hemorrhage, we believe filling the part be- 
 neath the tongue with dry lint, and holding it there some time, 
 would answer better than Mons. Petit's contrivances, provided 
 it be not an artery. We have seen, within a few days, a bleed- 
 ing from the fraenum, occasioned by a cut with a piece of tin 
 with which the child had been playing: the artery, in this case, 
 was taken up, by Dr. J. R. Barton, with great skill, and as much 
 success. 
 
 CHAPTER XV. 
 OF BLEEDING FROM THE NAVEL-STRING. 
 
 1157. This accident cannot properly be called a disease; yet 
 it is of importance to understand its management when it occurs, 
 that it may not prove injurious or fatal to the child. Whatever 
 reasoning ingenuity may employ, to prove that a ligature upon 
 the cord of a new-born child is unnecessary, experience shows, 
 it is sometimes highly useful; consequently, since if properly ap- 
 plied it can never do harm, it should always be employed. 
 
 1158. Those who are well acquainted with midwifery, know, 
 that sometimes a bleeding from this part takes place, hours 
 after it has been carefully secured; therefore, this part should 
 occasionally be watched, lest a bleeding ensue, and weaken the 
 child very much. We have never known an instance of death 
 from this cause, though we have seen children very much ex- 
 hausted by it. 
 
 1 159. This hemorrhage arises from the substance and vessels 
 of the navel-string contracting so as to be no longer compressed 
 by the ligature: this, however, only happens, so far as our ob- 
 servations go, from two causes; namely, 1st, where the cord has 
 been carelessly tied, or tied with improper substances ; in neither 
 of which, sufficient compression is made upon the vessels, though 
 at the moment of cutting the cord they did not bleed; 2dly, 
 where the cord is unusually large ; in this case, it is oftentimes 
 very difficult to make sufficient pressure upon the vessels, how- 
 
350 OP BLEEDING FROM THE NAVEL-STRING. 
 
 ever proper the materials of the ligature may be, or however 
 well it may have been applied ; for the cord shrinks in such 
 cases so much, as almost to leave the ligature without pressure. 
 
 1160. We onee witnessed a bleeding from the cord, which 
 had nearly proved fatal, where the vessels under the ligature 
 were completely compressed ; therefore, there was no blame to 
 be attached to the mode of tying, or to the substance of which 
 the ligature was made. As this case was a little singular, we 
 will relate it: — 
 
 1161. We were sent for, in great haste, to see a child who 
 was said to be bleeding to death. When we arrived, we found 
 it extremely pale, and nearly exhausted by a bleeding from the 
 cord. The child was three days old ; it had been bleeding 
 more than an hour. The gentleman who had delivered the 
 child could not be found at the moment he was sent for, but ar- 
 rived immediately after we had got the cord exposed. 
 
 1162. Upon examining its extremity,. not a drop of blood was 
 seen to issue from it, but a stream was observed to flow over the 
 child's belly. The whole cord was now unwrapped, and the 
 blood was seen to issue from the side of the cord, about an inch 
 below the tying. Upon examining this part carefully, it was 
 found that the vein was varicose, and had ulcerated — from this 
 ulceration the blood flowed. A new ligature was applied below 
 the ulceration, the bleeding stopped instantly, and the child re- 
 covered. We will not pretend to account for the blood of the 
 child forcing its way into the umbilical vein after the cord had 
 been cut; we only relate the fact, which suggests the following 
 practical cautions: never to apply a ligature above a varicose 
 portion of the cord, if it be possible to apply one below, lest a 
 similar accident may occur. 
 
 1163. When bleeding takes place from the extremity of the 
 cord, 1st, let a second ligature be applied below the original one, 
 taking great care that the second one shall not cut through the 
 cord when drawn very tightly ; 2dly , that the ligature be drawn 
 sufficiently tight to compress the vessels. To prevent the first 
 accident happening, do not let the ligature be of thread, hard 
 twisted together, especially the homespun thread ; and, to en- 
 sure the second, let it be a portion of a skein of fine linen 
 thread ; for neither tape, bobbing, nor cotton thread', can be 
 relied on for this purpose. 
 
OF ULCERATION OF THE NAVEL. 3£>1 
 
 CHAPTER XVI. . 
 
 OF ULCERATION, OR IMPERFECT HEALING OF THE 
 
 NAVEL. 
 
 1164. The umbilical cord separates from the umbilicus, from 
 the fifth to the tenth day; and though this is a process altogether 
 of the system of the child, yet we are occasionally obliged to 
 interfere, that the separation may be entire, or the healing per- 
 fect. 
 
 1165. The cord sometimes remains attached' by a filament, 
 for several days after the usual time of- separation : when this is 
 observed, it should be separated by dividing the connexion by 
 a pair of scissors. This is the simplest impediment to healing: 
 this process may fail by the part shooting up a kind of fungus, 
 which discharges a purulent matter, and is sometimes offensive. 
 This condition of the navel always excites alarm, though there 
 is no positive danger; the only disadvantage is, that the part 
 will not spontaneously heal, nor the discharge stop. 
 
 1166. This excrescence will be found in one of three condi- 
 tions: 1st, the navel may exhibit an elevated ulceration of its 
 whole surface ; 2dly, it may form a kind of button with narrow 
 base or pedicle; 3dly, this button may have a broad base, each 
 of which will require a little difference in management. 
 
 Treatment in the First Situation, . 
 
 1167. This condition of the navel will be readily healed by 
 sprinkling it with white lead, or finely powdered Aleppo galls, 
 or calomel. All these substances act as escharotics; when 
 either is applied, the surface immediately below becomes killed ; 
 therefore, time must be given for the slough to come off. When 
 it separates itself, a fresh portion must be applied, and so orl 
 until the part is entirely healed. 
 
352 OF HYDROCELE. 
 
 Treatment in the Second Situation. 
 
 1 168. A dark*red round tumour may be discovered within the 
 cavity, formed by the retiring of the navel ; this, when pressed 
 out, will have a foot stalk, and much resembles a cherry attached 
 to its stem. All that is necessary here, is to pass a ligature 
 round it, and sufficiently tightened. It will soon drop off, and 
 occasion no pain. It sometimes may not immediately heal after 
 the removal of the top, as the remaining portion may again 
 shoot up a new product — if this happen, the remedies named 
 for the first condition will quickly relieve it. 
 
 Treatment in the Third Situation. 
 
 1169. Eor„this.^coildition, a ligature cannot be applied, as its 
 base is broad — we are, therefore, obliged to depend upon escha- 
 rotics, as in the first case. It, however, will not always yield to 
 the already suggested remedies : when this is the case, we have 
 been a few times obliged to have recourse to a pretty strong so- 
 lution of the nitrate of silver ; this must be applied by means of 
 a camel hair pencil, and repeated until the part heals. We have 
 never Jmown this application give pain ; unless it were too libe- 
 rally used, and made to act upon the sound skin. 
 
 CHAPTER XVIL 
 
 OF HYDROCELE. 
 
 1170. This affection of the scrotum resembles that of adults ; 
 most probably, in many cases, the child is born with it ; it is, 
 however, not generally noticed until four or five days, and some- 
 times even longer after birth. It always eicites a good deal of 
 alarm; and it is proper it should, as it always deserves attention ; 
 not so much for itself, since it is of easy management, as because 
 a rupture at the part resembles it. 
 
 1171. It may be distinguished from hernia, by its equal dis- 
 
OF UMBILICAL HERNIA. - 353 
 
 tention; by its transparency; by not being increased by the cry- 
 ing of the infant; its want of sensibility on handling of it, and 
 by not retiring by pressure. So far as we have seen, the water 
 is confined to one side of the scrotum ; it may, however, be oc- 
 casionally in both. We have several times seen the tumour as 
 large as a small hen's egg. This complaint is not always con- 
 nate; we have seen it occur several months after birth; and, in 
 one case, several years. It is never productive of incon- 
 venience to the child, yet it demands attention. 
 
 1172. It has always yielded to the application of cold water, 
 though we have occasionally found it obstinate. This is espe- 
 cially the case, perhaps, when h>does not take place for a long 
 time after birth — at least, it was so in an instance, in which 
 this disease did not appear until after the child was three years 
 old. In this case, the water was steadily applied morning and 
 evening for several weeks, without any apparent amendment. 
 The child was now confined to a milk and vegetable diet ; and 
 took daily, or every other day, ten grains of cream of tartar, 
 and six of jalap. In this way he was purged pretty freely for 
 a fortnight; the water was, however, continued during the 
 whole of this time, and in a fortnight more, the whole tumour 
 disappeared : nor has the child had any return. 
 • 1 173. The best mode, we belie ve> to use the water, is to pour 
 it from a height, pleno rivo upon the /part. Two quarts, aj least, 
 of water should thus be let fall, morning and evening, through 
 the spout of a tea-kettle. 
 
 CHAPTER XVIII. 
 
 OF UMBILICAL HERNIA. 
 
 1174. We have adverted to the cause of hernia, in several 
 places, but particularly in Book I. p. 80, under the head of Bel- 
 ly-band ; as well as at p. 259, under the head of Exercise. When 
 treating of the application of the belly-band, we gave it as our 
 opinion, that the too tight application of this bandage was no un- 
 frequent cause of this complaint, when, from the conformation 
 
 45 
 
354 OF UMBILICAL HERNIA. 
 
 of the parts, there was a disposition to it. We then suggested 
 some cautions, to which we must beg leave to refer. 
 
 1175. It may be proper to observe, that the nurse is always 
 blamed when this accident happens, but not with sufficient rea- 
 son; for we do not believe it to be in her power always, nay, 
 we may say it is very rarely so, to prevent it; for, in general, 
 it is owing to a natural defect of the part. Yet a prudent care 
 is essential to the good health of the child. It must be remarked, 
 that children who cry a great deal, and who have had very 
 large umbilical cords, are more subject to it than others. 
 
 1176. It would be well for the nurse to examine this part 
 from time to time after the separation of the cord, especially 
 while the child is crying. Should she discover any pouting out 
 at thisLpart, she should immediately inform the parents of the 
 circumstance, and not reprehensibly conceal it, from a fear she 
 may be blamed for the accident. 
 
 1177. Much important time is sometimes lost by this conceal- 
 ment ; yet it is expecting rather too much moral courage in the 
 nurse to discover it, as she is sure to call the blame upon her- 
 self, by her candour. On this account, it is every way impor- 
 taot to be understood, how seldom, and how little agency the 
 nurse has in its production. It is but justice to that class of 
 people to declare the truth upon this point. 
 
 1178. As soon as this disease is discovered, it would be well 
 to attempt to remedy it; 1st, because we are persuaded the best 
 chance of a cure is, when it is taken as early as possible, that 
 the passage for the gut may not be confirmed by the frequent 
 appearance of this part in the opening, which will be sure to be 
 the case whenever the child cries, coughs, sneezes, or even goes 
 to stool, if the part be not protected by a counter pressure : — 
 2dly, because at this early period there is a natural disposition 
 in the hole through which the gut is forced to obliterate itself. 
 
 1179. Dr. Underwood, and others, recommended at first, 
 compression by straps of adhesive plaster : this plan has not 
 always succeeded with us, though it sometimes does. But we 
 never fail to cure it, by the application of Dr. Hull's umbilical 
 truss. This is simple in its construction, correct in its princi- 
 ples, and gives but very little trouble in its action. 
 
OP INGUINAL HERNIA. 355 
 
 CHAPTER XIX. 
 OF THE INGUINAL HERNIA. 
 
 1180. This complaint is not so frequent as the umbilical, but, 
 generally speaking, it is of more difficult management, and of 
 more serious consequence. This complaint consists of a 
 descent of a portion of intestine or omentum, into the scrotum: 
 it may exist before birth, or may take place soon after. 
 
 1181. This complaint may be suspected, whenever the scro- 
 tum, especially on one side, is more than usually large; and it may 
 be detected by the tumour being removed by pressure, and by 
 the testicle not being discoverable. This disease may, however, 
 take place at any period of life, but especially during its mo'st 
 active stages. 
 
 1182. Dr. Underwood says, the "bubonocele may be safely 
 left without a bandage, especially as the cold bath alone gene- 
 rally cures it, when happening to children before they go alone." 
 We are always sorry wheirwe are obliged to differ with this 
 respectable author ; and the complaint under consideration is 
 one of the instances, in which we are obliged to oppose the ex- 
 perience of Dr. Physick, as well as our own, to what he has 
 advanced in the quotation just mentioned. 
 
 1183. Dr. Physick advises, without reserve, the application 
 of a properly constructed truss to the part, whenever the disease 
 may be discovered ; and considers it unsafe to permit the child 
 to do without one : especially as the disease, if it be properly 
 managed by a well adjusted truss, is permanently cured ; but if 
 it be permitted to continue without such application, it may be- 
 come strangulated, or the disposition of the hole to contract, 
 through which the gut descends, is lost, and thus the child ever 
 continues to suffer under this complaint. 
 
 1184. We would, therefore, advise in conformity with an ex- 
 perience at once so extensive and valuable, as that of Dr. Phy- 
 sick, that recourse be immediately had to the only certain reme- 
 dy. In using a truss, however, for this purpose, much care is 
 required; 1st, that the machine be properly constructed, for the 
 
356 OP ABSCESS OF THE HIP JOINT. 
 
 end proposed ; and, 2dly, that it be properly adjusted to the 
 parts, that the end may be ensured ; 3dly, that the protruded 
 parts be carefully replaced before it is applied ; 4thiy, that it be 
 worn day and night. 
 
 CHAPTER XX. 
 
 ABSCESS OF THE HIP JOINT. 
 
 1185. The commencement of inflammation in the hip joint, is 
 not perceived as early as would be useful to the patient; or, if 
 some alteration in the health and vigour of a limb be observed, 
 it is not always attended to sufficiently early. This complaint 
 is most frequent with children ; the variety of little injuries 
 which they must almost necessarily sustain in the exercise of 
 their juvenile sports, misleads, very often, even anxious and 
 watchful parents, when any slight complaint is made of pain, 
 uneasiness, stiffness, or even diminished ability to walk ; since 
 they are all in their turns attributed to a bruise, a fall, or a 
 .wrench, which they suppose will quickly pass away by rest. 
 
 1186. Even after the disease has progressed some time, and 
 mn evident weakness is observed in the limb, by its being fa- 
 voured at the expense of the other ; when pain is felt from mo- 
 tion, and there is a disposition to fall, from slighter causes than 
 usual; and even when the points of the toes look more inward, 
 or outward than natural ; the true nature of this disease is not 
 suspected, as there is no fixed pain in the hip joint, not even 
 upon pretty hard pressure — indeed, the friends of the patient 
 are constantly misled* by his declaring he feels no pain, except 
 in the knee. 
 
 1187. If the two limbs be compared, even before the disease 
 has proceeded far, the diseased one will be found rather longer 
 than the other. After awhile, the natural convexity of the hip 
 is lost; and when the patient walks, it is found that the greater 
 part of the weight of the body is sustained by the sound limb, 
 and a limping commences. Though the patient locates his incon- 
 
OF ABSCESS OF THE*HIP JOINT, 357 
 
 venience in the knee, because he there alone very often feels the 
 pain, yet this part will bear pressure, and motion, without ex- 
 periencing the least inconvenience ; but not so always, the hip 
 joint; for if the sensations of the patient be carefully examined 
 during the motions imposed upon the knee joint, such as bend- 
 ing it, and straightening of it, it will be found he experiences 
 inconvenience in the joint of the hip. 
 
 1188. This is the commencement of inflammation of the hip 
 joint; and if it be not controlled in due time, it runs on to sup- 
 puration. An abscess forms, which opens, and gives issue to 
 an unhealthy pus; Jhe bones at the bottom of tbe abscess but 
 too frequently become carious; hectic fever -ensues; and, after 
 suffering, of a longer or shorter duration, the patient dies ex- 
 hausted, by discharges and sufferings. 
 
 1189. For remedies to be useful in this disease, they should 
 be early applied, regularly persevered in, and the most perfect 
 rest enjoined upon the patient ; with such treatment, the disease 
 may frequently be cured; but if the disease have been neglected 
 in its early stage, the remedies but partially administered, and 
 the patient permitted to use exercise, the disease then becomes 
 as painful as hopeless. 
 
 1 190. The cure must be attempted, by bleeding, leeching, cup- 
 ping, purging, low diet and rest. We have seen three instances 
 of entire restoration where this plan was completely tried; and 
 we have witnessed more than twice that number, terminate in 
 incurable lameness; fistulous openings with never-ceasing dis- 
 charges of ill-digested pus, and death, from hectic, will follow. 
 
 1191. From pain being seated in the knee, this complaint is 
 always mistaken for rheumatism, or some other local affection 
 of this part ; and to it are all the remedial powers addressed — 
 we need not say how unavailingly. 
 
 1 192. To Dr. Physick we are indebted for the proper mode of 
 treating this affection ; and to his happy genius are hundreds un- 
 der obligation, who have suffered from it, for the preservation of 
 their limbs, and for the enjoyment of life. It was he who first 
 suggested constant purging, and entire rest ; and to which, this 
 formidable disease so often yields, when tried under proper cir- 
 cumstances. Valuable as this plan is, it must be confessed to be 
 one of difficult execution; but we know, from experience, it is 
 not impracticable ; and from the same experience, we know it to 
 
358 OP ABSCESS OF THE HIP JOINT. 
 
 be successful. Who, then, would hesitate to enforce a plan, that 
 might save a lovely female from an incurable lameness, or a 
 favourite son from a lingering death! 
 
 1 193. But let us be a little more particular, in developing the 
 plan just spoken of. The child must abstain from all animal 
 food or broths ; he must be laid prostrate upon his bed or mat- 
 tress, and this without exercising the limb, but as little as possi- 
 ble : he must be bled freely from the arm, if the pulse be active, 
 or leeched upon the hip, if the bleeding be not indicated: these 
 must be repeated in proportion to pain, or fever; if either come 
 on. The bowels must be purged daily, or every other day, by 
 the exhibition of cream of tartar and jalap, in doses suited to the 
 age of the patient, and this persevered in until amendment is 
 obvious, or the cure completed, Under this apparently weak- 
 ening plan, it is astonishing, sometimes, to see how health and 
 strength improve. Where it is impossible to confine the patient, 
 much advantage is found from the curved splint, made to fit the 
 hip and thigh. The ingenious Mr. William Rush, (ship-carver,) 
 is very successful in adapting the splint to the shape of the 
 parts concerned. To show how easily, and commonly, this case 
 is mistaken for rheumatism, we will relate one case, of several 
 of similar kind. In June, 1823, we were requested to visit 
 
 Miss , aged fourteen; she was from the country; she was 
 
 there treated for a rheumatism in the knee, by stimulating, and 
 other applications, for some time. At the request of a relation 
 residing in the city, she was brought down for farther advice. 
 We soon discovered the complaint to be a hip disease ; and we 
 wrote a letter of instructions for its treatment. After our taking 
 leave, it was agreed she should remain in town to put the pro- 
 posed plan in execution, and she, accordingly, commenced forth- 
 with, and this with as much perseverance as success. She was 
 bled arid leeched twice; purged every day, or every other day, 
 at farthest, with jalap and cream of tartar; confined closely to 
 her bed ; and observed the most abstemious diet, for two months ; 
 at the end of which time, we had the pleasure to return her to 
 i her anxious parent perfectly restored ; and up to this time re- 
 mains well. But every case is not so quickly relieved. Dr. 
 Physick and myself had a very desperate case lately, which re- 
 quired six or seven months to cure ;* but which was in this 
 
 * That is, the inflammation of the joint was subdued, and the threatening 
 
OF ABSCESS WITHIN THE EAR. 359 
 
 time happily effected. The splint was modelled to the shape of 
 the leg, three times, as it required length during the progress of 
 the cure. 
 
 CHAPTER XXI. 
 
 ABSCESS WITHIN THE EAR. 
 
 1194. Children, after they are six months old, are sometimes 
 found to cry violently, and toss their little heads from side to 
 side, expressing thereby the greatest agony. Not being able to 
 point out the seat of pain, it is variously located by the parent 
 or by the practitioner. It will sometimes stop crying very sud- 
 denly, and fall into a sound sleep, from which it will be roused 
 by renewed torture. This pain is not generally attended by 
 any disturbance of the system : fever seldom attends, but when it 
 does, it is sometimes very high, and even attended by delirium. 
 It is generally mistaken for colic, or belly-ache. 
 
 1195. It may, however, readily be distinguished from this af- 
 fection, by its not being accompanied by drawing up of the legs 
 and thighs ; by no flatus rumbling in the bowels, and by the 
 hands and feet not being cold, or by the pain not being relieved 
 by remedies addressed to these parts. We have always reason 
 to suspect this pain to arise from an abscess forming in the ear, 
 when the child throws its head backward and forward, and in- 
 deed in all directions, during the paroxysms of pain; when it is 
 found to lie on one side easier than the other; when laudanum 
 procures but temporary relief ; and when, upon pressing the ear 
 with the point of the finger placed against the lower portion of 
 the external meatus, it complains ; and, above all, when the ab- 
 scess can be discovered by looking into the ear; this, however, 
 but seldom happens. 
 
 1196. We have witnessed this affection so frequently, and 
 have been so often alarmed by it, that we always apply remedies 
 
 symptoms had ceased. But as the limb was very much contracted, it required 
 the constant application of the splint for a number of months more before it be- 
 came straight. This young- lady now walks without much difficulty, though the 
 disease was for a long time a very serious one. 
 
360 OF ABSCESS WITHIN THE EAR. 
 
 to the ears, when we have satisfied ourselves the pain is not in 
 the bowels, by the absence of the symptoms noticed above, nor 
 in the head itself, by the absence of all fever, or derangement 
 of stomach. 
 
 1197. When we suspect the ear to be in fault, and have beer* 
 called to the child in the commencement of pain, we almost in- 
 variably order a few leeches to be applied under that ear of 
 which the child complains, if pressed, as above directed. We 
 also direct a little laudanum on lint pressed gently into the ear, 
 and this repeated as occasion may require. . Should these fail 
 to afford relief, we advise a blister to be applied immediately 
 under the ear; and purge the child pretty briskly. 
 
 1198. This plan sometimes succeeds to admiration, and we 
 believe it would oftener do so, were the remedies applied suffi- 
 ciently early: but unfortunately, the time for useful exertion is 
 almost always lost, by a trial of temporizing applications; and 
 we have but too often the mortification to witness only the dis- 
 charge from the ear. ' When the ear discharges, the little pa- 
 tient is immediately relieved : it falls into a sound sleep, and 
 forgets all its sufferings; until again it is obliged to go through 
 the process a second, and even a third time, in the period of 
 two or three months. 
 
 1199. Sometimes the abscess heals without the smallest trou- 
 ble, leaving the ear free from discharge in the course of a few 
 days ; but at other times, the mischief done the inner cavity of 
 the ear is serious and permanent. The small bones of the ear 
 become detached by suppuration, and are discharged with the 
 pus which constantly flows from the external orifice of this organ. 
 The discharge generally becomes very offensive ; both from the 
 matter being confined, as well as from the caries under which 
 the bones are labouring. When caries takes place, the case is 
 almost hopeless; and must, in a great measure, be abandoned to 
 nature, only paying attention to cleanliness. It also happens, 
 that the inflammation of the fibro-mucous membrane of the tym- 
 panal cavity travels backwards to the mastoid cells, and even 
 proceeds towards the brain itself, through the fenestra cvalis, and 
 fenestra rotunda in the vestibule, and the cochlea respectively; 
 and may thus be transmitted to that portion of the dura mater 
 which covers the petrous portion of the temporalbone — and 
 hence, we may have delirium, suppuration, exfoliations, and 
 death. 
 
OF ADHESION OF THE LABIA PUDENDI. 361 
 
 1200. It is a matter of primary importance to keep the parts 
 clean by frequently washing out the canal of the ear, first with 
 fine soap and warm water, followed by equal parts of lime-water 
 and milk, and a small portion of the tincture of myrrh. Our for- 
 mula for this purpose, is as follows: 
 
 Of lime-water and milk, each two tea-spoonsful; 
 Tincture of myrrh, twenty drops. Mix. 
 
 1201. This mixture should be prepared only as it may be 
 wanted, and thrown into the ear four or five times a day. At 
 night, the child should be made to lie upon the affected side, 
 that the matter may discharge freely. 
 
 1202. This discharge from the ear is always attended by dul- 
 ness of hearing: oa this account, it were desirable it should be 
 relieved as quickly as possible, lest its continuance do irrepara- 
 ble mischief to this organ. The mixture of lime-water and milk, 
 when no serious injury has been done to the bones of the ear, 
 will, if properly persisted in, very often succeed ; and we are in- 
 formed, by a late writer on this affection, that a solution of the 
 nitrate of silver will be found a most valuable application. 
 
 1203. We think we have seen advantage from the little patient 
 wearing a plaster spread with Burgundy pitch, or shoemaker's 
 wax, under the affected ear. And we once witnessed a case of 
 years' standing, yield to an issue in the arm of the side affected. 
 This was kept discharging for a year : it was then suffered to 
 heal, which it did without any subsequent disadvantage. 
 
 CHAPTER XXII. 
 
 OF ADHESION OF THE LABIA PUDENDI OF 
 CHILDREN. 
 
 1204. The labia pudendi of young children are very often 
 found adherent. This may be congenite,but we believe it is very 
 rarely so. We have seldom seen this condition of the parts in 
 children under six months old ; and still more rarely, after the 
 age of a year. From these facts, it would seem to be almost 
 always adventitious, and owing principally to a want of cleanli- 
 
 46 
 
362 OF ADHESION OF THE LABIA PUDENDI. 
 
 ness. Had the child been born with the labia in this condition, 
 it is more than probable it would have been discovered early, as 
 nurses, generally speaking, are, at least, curious, if not always 
 careful, in their examinations. 
 
 1205. When we consider the delicacy and vascularity of the 
 membrane lining the internal fa*ce of the labia; the ease with 
 which inflammation maybe provoked, in parts so organized; 
 when we recollect how quickly the secretions of the parts be- 
 
 . come acrid, where proper attention is not bestowed upon them ; 
 and how easily a slight inflammation may be increased, by the 
 frequent flow of urine; we shall cease to wonder at the frequency 
 of this complaint, and, perhaps, only be surprised, that it does 
 not more frequently occur. 
 
 1206. We have reason to believe, in many instances, this com- 
 plaint had existed some time before it was discovered ; this may 
 especially be the case with fat or lusty children, and where the 
 most scrupulous attention is not paid to the condition of these 
 parts. Therefore, it must be looked upon, in general, as a most 
 reprehensible piece of neglect; for it is the bounden duty of every 
 mother, however averse she may be from its performance, to 
 carefully inspect these parts from time to time, particularly un- 
 til the child is fifteen or eighteen months old, in order that the 
 inconvenience under consideration may not take place. 
 
 1207. Parents should direct, and the performance should be 
 insisted on from nurses, that these parts should be regularly 
 cleansed every time the child is washed, by separating the labia 
 and applying water to them liberally; they, should then be ten- 
 derly dried with a soft linen cloth, and dusted with hair powder, 
 or powdered starch, in which there is no indigo. If this were 
 regularly done in early infancy, the parts would become so har- 
 dened, as very much to diminish the risk of this accident taking 
 place. 
 
 1208. We have dwelt upon this subject, because we know its 
 importance ; and because it has not sufficiently attracted the at- 
 tention of parents. Unfortunately for the female, sometimes it 
 has not been discovered during infancy; and it is especially so, 
 when it remains concealed until womanhood, when, perhaps, the 
 firSjt intimation she may receive of her situation, is at a time, 
 when of all others she would wish to have been ignorant of it 
 The alternative, now, subjects her to an operation which should 
 
OF ADHESION OF THE LABIA PUDENDI. 363 
 
 have been performed in early life ; and by which all the finer 
 feelings are excruciated with a severity, that can be better 
 conceived than described. 
 
 1209. This complaint sometimes becomes relieved spontane- 
 ously, but not always happily; and this may occur more fre- 
 quently than we are aware of; since the causes which may pro- 
 duce it, are too constantly operating, not to lead us to suppose 
 this accident to occur, in cases where it may not be detected. 
 We had two instances of this spontaneous change to happen 
 under our own observation. 
 
 1210. In one of these cases, there was so much inflammation 
 and tenderness in the parts, that we did not think it advisable to 
 operate, until the existing state of things was changed. We di- 
 rected soft bread and milk poultices, and a cathartic. On our 
 next examination, a complete separation had taken place ; by 
 the adhering parts having suppurated, and exposing two raw 
 surfaces, which required much attention to prevent reunion by 
 their healing. 
 
 1211. The other case was something similar; suppuration had 
 commenced, and the connecting medium was nearly destroyed, 
 when it was first observed. It was poulticed, as in the other 
 case ; and when about to heal, care was taken to prevent a se- 
 cond coalescence of the parts. 
 
 1212. This condition of the labia is easily detected, by their 
 refusing to be separated. When the parts are distended as much 
 as their condition will permit, a continuous line of adhesion will 
 be observed through the whole track of the labia, as far as the 
 meatus urinarius ; of course, the os externum of the vagina is 
 entirely concealed. The child passes its water without much 
 difficulty ; and when the complaint has been suffered to run on, 
 or is not discovered until womanhood, the menstruous fluid has 
 been evacuated through the same external aperture, by which 
 the urine was discharged. 
 
 1213. There is but one remedy, that we know of, for this 
 complaint — and that is, to divide the parts. This is very easily 
 performed, by passing a probe-pointed bistoury into the orifice 
 immediately before the meatus urinarius, and cutting downward 
 to the inferior junction of the labia. A small dossil of lint, moist- 
 ened with sweet oil, may be insinuated between the separated 
 portions. The wounds heal without the smallest difficulty, in 
 
364 OF THE DIABETES OF CHILDREiY. . 
 
 two or three days. Dr. Denman recommends, for the removal 
 of these adhesions, that the labia be forcibly separated, so that 
 they may be destroyed. We look upon this method as much 
 more painful than the knife, and certainly not more efficacious. 
 See Diseases of Females, by the Author, p. 26. 
 
 CHAPTER XXIII 
 
 OF THE DIABETES OF CHILDREN. 
 
 1214. This complaint was first noticed by Morton, agreeably 
 to Dr. Underwood ; he considered it altogether a sympathetic 
 affection, and we believe correctly — at least, the three cases 
 which we have witnessed, happened to children who were teeth- 
 ing. It should not surprise us, more, that the kidneys hold in- 
 tercommunion with the gums, during teething, than that the 
 neck of the bladder should ; and of this we see frequent instances. 
 
 1215. -Morton speaks of this disease as a family complaint; 
 having proved fatal to all the male children, with the exception 
 of the last, which was under his care, and appeared to be re- 
 lieved by the plan he adopted — namely, confining the child en- 
 tirely to a milk diet ; and, to allay the excessive thirst, he al- 
 lowed only milk, mixed with a chalybeate water. The diabetic 
 symptoms, in this case, were wont to return, with every tooth 
 that was about to pierce the gums. 
 
 1216. This complaint consists in the immoderate discharge of 
 urine, attended with great thirst and emaciation. In Morton's 
 case, the urine was as sweet as that of adults labouring under 
 this complaint. In those we witnessed, we regret to say, we 
 could not procure the urine to make a trial ; and, therefore, can- 
 not tell whether it was sweet or not. All the children we have 
 seen with this complaint, were under fifteen months old ; and, 
 though teething, yet from a careful examination of the mouth, 
 we could not, in either of these cases, find teeth immediately 
 protruding the gums. 
 
 1217. The quantity of urine discharged was very great; and 
 
OF INCONTINENCE OF URINE. 365 
 
 this at very many times ; the children fell away rapidly, and 
 weakened very fast. We ordered the bowels to be kept freely 
 open ; and a quantity of the spirit of turpentine to be put upon 
 the clothes of the children, so as to keep them in a terebinthi- 
 nate atmosphere. This plan succeeded completely in every 
 case. 
 
 CHAPTER XXIV. 
 OF INCONTINENCE OF URINE. 
 
 1218. This is more frequently a disease of habit, than of any 
 derangement of the sphincter of the bladder, or a symptom of 
 stone, or calculi ; yet it may occasionally proceed from either. 
 
 1219. If this complaint arise from the presence of a stone in 
 the bladder, it is evident that nothing but the removal of it can 
 effect a cure, if from a lithic disposition in the urine, it may be 
 sometimes improved by repeated doses of magnesia ; soda, su- 
 persaturated with carbonic acid gas ; lime-water and milk ; a 
 few drops three or four times a day, of the spirit of turpentine, 
 or of balsam, copaiva, &c. 
 
 1220. But when it is purely the effect of habit, as it most fre- 
 quently is, nothing but the destruction of the habit can afford 
 relief. This may be done, 1st, as directed, very properly, by 
 Dr. Underwood, by taking the child up from its bed, after it has 
 been there awhile, and obliging it to remain on the pot until it 
 discharge its urine ; having previously, however, seen that 
 it had emptied its bladder before it went to bed. Or, 2dly, by 
 such remedies as appear to alter the condition of the neck of 
 the bladder ; rendering it less susceptible to the irritation of the 
 urine, and by instituting new associations ; by creating new sen- 
 sations, or susceptibilities in it ; as by the tincture of cantha- 
 rides, in doses of ten or twelve drops, three or four times a day, 
 in a little sweetened water; gradually increasing the dose two 
 or three drops at a dose, until heat is perceived in making wa- 
 er ; it must then be desisted from ; and, should strangury ensue, 
 let it be quieted by drinking freely of flaxseed tea, gum Arabic 
 water, or any other demulcent — if severe, by three or four 
 
366 OF CONSTIPATION. 
 
 grains of camphor, and a few drops of laudanum, or the warm 
 bath. Mr. Lair proposes the introduction of the tincture of 
 cantharides into the urethra by means of a catheter, so as to 
 apply it to its prostatic part. By this means, he declares, he 
 cured three patients of incontinence of urine. Med. Chirur. 
 Rev. for January, 1827, p. 244. 
 
 1221. Blisters, applied to the sacrum we have found highly 
 beneficial ; or even plasters of Burgundy pftch, upon the same 
 part. A most interesting case of this kind fell lately under our 
 care, which it may be useful to relate. A delicate boy eleven 
 years of age, was severely afflicted with this weakness, from an 
 early period of his life. Every precaution likely to interrupt 
 the habit, was unavailingly had recourse to. During the day, 
 he was constantly running to discharge his bladder, so that he 
 was obliged to neglect even his education; and, at night, it 
 seemed to^ pour from him in almost a continuous stream. These 
 discharges were attended by severe suffering at the neck of the 
 bladder ; so much so, that it led us to suspect there might be a 
 stone in the bladder ; and we begged that our friend, Dr. Phy- 
 sick, might examine him — this was done, and no stone was 
 found. The poor boy suffered considerably in the passing of 
 the sound ; the parts became a little inflamed, and his urine sup- 
 pressed. By the use of neutral salts, laudanum, and the warm 
 bath, he was pretty soon relieved of the suppression ; and with 
 it passed away almost entirely his inability to retain his water. 
 The black drop was ordered him at night, with the most mani- 
 fest advantage — this he continued for a long time. We were 
 unwilling to interrupt the use of this medicine, until convinced 
 that the irritability of the bladder was destroyed — this took 
 place in a few months after. 
 
 CHAPTER XXV. 
 
 OF CONSTIPATION. 
 
 1222. Tardy bowels may be either accidental, or constitution- 
 al : if the former, it is always well to inquire into the cause, that 
 
OF CONSTIPATION. 367 
 
 it may be removed as quickly as possible. The bowels of infants 
 may become costive, from improper food, or food, which, in it- 
 self, may be proper in some constitutions, yet may produce cos- 
 tiveness in others. Thus, we find rice, in all its preparations, 
 will, sometimes, make the bowels of some children tardy: when 
 this is found to be the case, it should not be employed under 
 any pretext. Again, boiled milk will have this tendency occa- 
 sionally, and so many other substances, all of which should be 
 laid aside, the instant they are known to produce this effect. 
 
 1223. But there is a cause of accidental costiveness that is 
 not generally known, which is much more injurious than that 
 from any other— namely, from laudanum. Nurses are now so 
 familiar with this drug, that it is as regularly carried about them 
 as their scissors or thimble, and is much more indispensable to 
 their comfort, than either of these emblems of industry. If the 
 child do not go to sleep, or it be even feared it will not, at the 
 exact moment which will suit the arrangements of the nurse; 
 or if it cry from any cause, so as to give any additional trou- 
 ble, laudanum is given to make " assurance doubly sure." 
 
 1224. The consequence is, that an accidental is converted 
 into an habitual, costiveness; or the child may fall a sacrifice 
 to convulsions, or other fatal diseases, before the disposition of 
 the bowels may be changed. In all instances of accidental cos- 
 tiveness, the child should be watched; and, if the bowels do not 
 seem inclined to relieve themselves, they should be aided by ar- 
 tificial means; and that very promptly, if the slightest indispo- 
 sition should manifest itself at this period. 
 
 1225. The most prompt application for this purpose, is an in- 
 jection; or even a suppository.* The former may consist of a 
 rich solution of molasses, in a gill, or even less of warm water, 
 to which may be added a pinch of common salt; the other may 
 consist of a piece of the common brown or rosin soap, of an inch 
 in length, and one-fourth of an inch thick, shaped round, and 
 slightly tapering to a point. This must be dipped first in water, 
 and then passed into the rectum, and pressed by the point of the' 
 finger beyond the sphincter ani. Either of these means will al- 
 
 * It maybe proper to observe, that in employing- a suppository, care should be 
 taken, that it be removed, either by a second application, or by an injection, when 
 it does not speedily produce its effect; and, especially if it excite an unsuccessful 
 effort to discharge itself. 
 
368 OF CONSTIPATION. ■ 
 
 most always procure the desired evacuation ; and may be made 
 always most safely, and very often most advantageously, to an- 
 ticipate the operation of other medicine. 
 
 1226. The most proper cathartic medicine for children, is cas- 
 tor oil, or magnesia. The quantity of either must be proportion- 
 ate to the age and habit of the child — 'from a tea-spoonful to a 
 table-spoonful of oil will be a dose for children, from a month 
 to two or three years old. Of magnesia, from one to two large 
 tea-spoonsful will be doses for the same ages. The castor oil 
 should always be given warm and alone; the magnesia should 
 be most intimately mixed with a little sweetened milk. Manna 
 may also be used as sweetening for the child's food — it may re- 
 quire from a quarter to half an ounce for a dose. 
 
 1227. When it is desirable to alter the costive situation of the 
 bowels as a habit, it is always better to do it by diet, than by 
 medicine. Molasses freely used, is excellent for this purpose; 
 but the best remedy we have yet met with, is a mush, made by 
 boiling a small quantity at a time, of the unbolted wheat flour, 
 in water, and straining it through a sieve, while hot. It will be 
 perceived, this must be made thin. A portion of this must be 
 used in the milk the child takes; or it may be fed with it a little 
 sweetened, two or three times a day, or oftener, or more sel- 
 dom, as the case may require. When this is properly attended 
 to, we have never seen it fail. 
 
 1228. But should this costiveness appear to have provoked 
 fever, induced pain, or excited convulsions, more active medi- 
 cines, as jalap, or calomel and jalap may be used; or the others, 
 namely, castor oil or magnesia, may be repeated every hour or 
 two, until the effect be produced. 
 
 1229. Constitutional costiveness, not attended by any de- 
 rangement of the system, rarely requires an interference. Dr. 
 Underwood asserts-, that the condition of the child's bowels 
 keep pace with those of the mother ; this is certainly very far 
 from being always the case. We have known the child very 
 costive, while the mother was not so, and the reverse. This 
 slow motion of the bowels may be from two days to ten, with- 
 out the child receiving the least injury from this torpor. 
 
 1230. We were once consulted for a child of six months old, 
 on account of its excessive costiveness; it had an evacuation but 
 once in eight or ten days, but was perfectly healthy; throve well, 
 
OF VOMITING. 369 
 
 and in every respect might be said to be in excellent health. We 
 advised that nothing should be done, as long as the child was 
 free from complaint.* What added to the peculiarity of this case 
 was, the relaxed condition of the mother's bowels ; she was sub- 
 ject to a kind of diarrhoea, the whole time of her suckling. The 
 child in question never required any medicine ; when it began to 
 cut its teeth pretty rapidly, its bowels became less confined, but 
 was never free in them, until after weaning. 
 
 CHAPTER XXVI. 
 OF VOMITING. 
 
 1231. Vomiting, with young children, is very far from always 
 being a disease. This fact should be well remembered by young 
 and inexperienced mothers, who are apt to become alarmed by 
 incidents, which sometimes only prove the healthfulness of their 
 children. Of this kind, very often, is the ^vomiting about to be 
 considered, which, if treated as a disease, by an incautious prac- 
 titioner, may really be converted into one ; whereas, if nature 
 be permitted to have the management, she will secure the health 
 of the child. 
 
 1232. But it will be asked, are we never to interfere with vo- 
 miting 1 — and, if we are, how shall we know when this interfe- 
 rence may be proper, or when it would be best to let it alone? 
 To answer these questions, it will be necessary to divide this act 
 into the idiopathic, or spontaneous, and sympathetic, or pro- 
 voked. 
 
 1^33. By the first, we are to understand, that eflbrt of the sto- 
 mach, which it almost invariably makes to throw off whatever 
 may be offensive to it, from its bulk rather than from its quality, 
 but in which the system at large has no participation. By the 
 second, we mean, 1st, that the condition which arises from its con- 
 nexion with other parts of the body, which, when in a state of 
 disease, through the medium of that power called sympathy, be- 
 comes irritated to vomiting ; or, 2dly, by the presence of some 
 acrid, deleterious, or undigested substance within its own cavity, 
 
 47 
 

 370 OP IDIOPATHIC VOMITING. 
 
 exciting it to this act; and, 3dly, when its powers are deranged, 
 and, consequently, its functions are not carried on in a healthful 
 
 manner. m 
 
 Sect. I. — Of Idiopathic Vomiting. 
 
 1234. Under this distinction, we must consider the throwing 
 off' the contents of the stomach in young children, and especially 
 those at the breast, when this organ has been compelled to re- 
 ceive too much; the dentition becomes a source of irritation, 
 and the act of vomiting, (or, rather of regurgitation, for it is 
 scarcely an effort,) is produced. Hence, we see children who 
 have been liberally supplied at the breast, often throw up the 
 greater part of that it had just before received. But this act 
 must not be considered a diseased condition of the stomach, or 
 one meriting medical attention. We, therefore, never interfere 
 with such cases so long as the child thrives, or the powers of this 
 organ are not deranged. 
 
 1235. When this kind of vomiting takes place, it is almost im- 
 mediately after the child has sucked; the milk comes up pure 
 and unchanged ; it is discharged without any seeming effort, or 
 nausea; and the moment it is removed from the breast, is cheer- 
 ful, and, apparently, happy; nay, it very often happens in the 
 midst of some expression of its healthfulness and happiness, and 
 this sometimes without altering the expression of cheerfulness. 
 Now, were this vomiting to be looked upon as injurious, and 
 treated as a disease, the evil intended to be removed, would real- 
 ly be created or increased. 
 
 1236. Though we do not consider this an unhealthy act, it is 
 not, or rather it should not. be made a necessary one of the sto- 
 mach; for it almost always proceeds from repletion, or from this 
 organ being disturbed by some rude handling of the child. To 
 prevent its taking place from the first cause, the child should 
 be taken from the breast the moment it begins to dally with it; 
 or when it ceases to draw, as if it were really gratifying a neces- 
 sary and proper appetite. If this be done, and the child suffered 
 to remain for awhile perfectly quiet after its removal from the 
 breast, this inconvenience, (for such it is,) will certainly cease. 
 But the too common practice of jolting and tossing the child, 
 (see Book I. p. 176, par. 575,) immediately after nursing, 
 
OF SYMPATHETIC VOMITING. 371 
 
 will be sure to derange its stomach, and vomiting will ensue — 
 therefore, this barbarous custom should be instantly forbidden. 
 
 1237. There is an error very commonly committed with chil- 
 dren who throw up frequently, which is, to apply them to the 
 breast immediately after they have discharged their little sto- 
 machs, under the pretence of " making up for what the poor 
 little thing has lost;" and thus, this evil is perpetuated; whereas, 
 to manage this case properly, the stomach should be allowed 
 to rest awhile. 
 
 Sect. II. — Of Sympathetic Vomiting. 
 
 1238. 1. This act of the stomach, may take place from af- 
 fections remotely situated from it, as in certain fevers;, affections 
 of the kidneys, the head, the neck of the bladder, &c, through 
 the medium of the nervous system. But in all such cases, the 
 stomach cannot very often be quieted except by the removal of the 
 original complaint. Dr. Underwood says, it may arise from " a 
 suppression of the discharge behind the ears, and, more espe- 
 cially, if consequent upon the use of drying remedies/' or, from 
 " the sudden disappearance of some eruption on the skin." 
 
 1239. We have never witnessed vomiting from either of the 
 two last named causes; and we more than suspect, that too much 
 has been taken for granted, unless it be where " drying applica- 
 tions " have improperly been made: in this case, we can readily 
 believe that injury might follow such imprudent practice; but 
 where the discharge 'from behind the ears, or the disappearance 
 of an eruption from the skin has suddenly taken place, it would 
 be right to inquire, what gave rise to the suppression of a dis- 
 charge in the one case, or to the retrocession of an eruption in 
 the other? for the cause capable of producing such effects, might 
 also produce the vomiting in question. 
 
 1240. The management, then, of vomitings of this kind, con- 
 sists almost exclusively, in the treatment of the original disease 
 which produced it. It is true, we occasionally succeed in miti- 
 gating this affection by remedies exclusively addressed to the sto- 
 mach, but not often; unless it be when the original disease itself 
 is yielding to treatment instituted for it. Then a little lime-wa- 
 ter and milk, soda water, or injections with laudanum, will some- 
 times succeed. For young children, that is, under a year, a tea- 
 

 372 OF SYMPATHETIC VOMITING. 
 
 spoonful of lime-water and as much milk, given once an hour, 
 will generally be sufficient; half a wine-glassful of soda water, 
 from time to time, may be given at once; or an injection of a ta- 
 ble-spoonful of warm water, and eight or ten drops of laudanum 
 may be administered. If the child be older, the dose must 
 be proportionably increased. 
 
 1241. 2. Where vomiting proceeds from some acrid or dele- 
 terious substance being received into the stomach, this action 
 should be encouraged by warm water, chamomile, or common 
 tea, or even cold water, until the offending cause appear to be 
 removed, which may generally, be determined by no more of 
 the offending substance appearing in what is ejected from the 
 stomach. When this is the case, a brisk injection of a gill, (or 
 more for an older child,) of warm water, and two large tea- 
 spoonsful of common salt, should be immediately given: should 
 this not operate speedily, it must be repeated until an evacua- 
 tion be procured. 
 
 1242. If the injection operate freely, it will very frequently 
 arrest the vomiting at once; but, should it not, it must be fol- 
 lowed by one in which laudanum enters;* the quantity regulated 
 by the age of the child. Upon this subject there is one general 
 rule, which it is well should be known; namely, that a child 
 will always bear by injection, three times the quantity of lauda- 
 num it will bear by the mouth. The remedies named above, 
 (the lime water, &c.,) may also be given to aid the injection. 
 
 1243. When the vomiting proceeds only from the child's 
 having taken more into its stomach, of its common, or even 
 some unusual food, than it can well master, its effects will very 
 generally cease after it has thrown up the undigested arti- 
 cles; and the disposition to do this, should be encouraged, as 
 just directed, by the exhibition of warm water, &c. Should 
 the vomiting not cease, however, when the stomach is freed 
 from the offending cause, a stimulating injection of salt and 
 water will, almost certainly, put an end to it. 
 
 1244. 3. When vomiting proceeds from the deranged powers 
 of the stomach, it is almost always owing, in young children, 
 either to an excess, or deficiency of acid, or to the too great ir- 
 ritability of this organ; (and either of these may be occasioned, 
 
 * In this case the quantity of water taken, should not exceed a table spoonful. 
 
OF SYMPATHETIC VOMITING. 373 
 
 and most commonly is, by the stomach sympathizing with the 
 gums, as in teething;) or it may arise from some inscrutable 
 cause, over which we can have no certain control, though we 
 often have it in our power to interrupt the effect ; or it may 
 proceed from some peculiar property in the mother's milk. 
 
 1245. If it proceed from an excess of acid, the child will throw 
 up its milk, completely curdled, in a few minutes after receiving 
 it. The curd will be of different degrees of density, as the acid 
 may be more or less abundant, or as the milk may have been a 
 longer or shorter time in the stomach. This may be accompa- 
 nied with either looseness or costiveness. If it be after the child 
 has commenced to cut teeth, the bowels are, for the most part, 
 loose ; but if before that period, it is very frequently attended 
 by costiveness. 
 
 1246. When an excess of acid prevails, it must be relieved 
 by antacids, in small, but repeated doses. If the bowels of the 
 child be loose, the best remedies we have found, are magnesia 
 and soda — the former in mixture, as follows: a tea-spoonful of 
 calcined magnesia, mixed in eight or ten of water or milk, with 
 three or "four drops of laudanum, and a little sugar. A tea-spoon- 
 ful of this every hour or two, very quickly allays the irritation 
 of the stomach, and quiets the disturbance of the bowels. 
 
 1247. Should the bowels be confined, the laudanum must be 
 omitted, and the mixture given, until the bowels are opened. Or, 
 should the bowels need no attention, the supersaturated soda wa- 
 ter, in small doses, will answer admirably well If the child re- 
 fuse to take the soda water, the lime water and milk, as just di- 
 rected, may*be given in repeated doses, until better. 
 
 1248. In these cases, the mere destruction of this acid, in most 
 instances, appears every way sufficient to relieve the stomach. 
 This circumstance cannot fail to surprise, since, at first sight r 
 this would seem to be but removing the effect of a cause, over 
 which we do not know that we have any influence; for one of 
 two things must happen, in these cases: either the acid is for- 
 mally secreted by the stomach in too large a quantity ; or the se- 
 cretions of the stomach, by some peculiar disposition of this or- 
 gan, become acid immediately after their formation. It is, there- 
 fore, difficult to understand how, in the first supposition, the de- 
 struction of the loose acid shall prevent the farther formation of 
 it'; and in the second, how it s^hall alter the action of the vessels. 
 
374 OF SYMPATHETIC VOMITING. 
 
 so as to change the tendency of the secretions to become acid, 
 when free in the stomach. 
 
 1249. It must be recollected, however, that every instance of 
 the child throwing up coagulated milk, must not be considered 
 an evidence of disease, or even of a superabundance of acid ; for 
 this change in the milk must take place before digestion is ac- 
 complished; therefore, in the most healthy and vigorous stomachs, 
 if vomiting be provoked some time after the child has sucked, 
 the milk may be thrown up in this condition. 
 
 1250. If there be a deficiency of acid in the stomach, and a 
 vomiting be produced, the milk will come up unchanged — nau- 
 sea almost always attends this variety; the child maybe observed 
 to become pale, and evidently to struggle against the efforts of 
 its revolting stomach. The milk is ejected with great force, in 
 a large column; and, not unfrequently, a portion passes through 
 the nostrils. 
 
 1251. We have rarely seen this condition of stomach fail to be 
 relieved by the occasional exhibition of small quantities of lemo- 
 nade. The acid drink, however, should be stopped, as soon as 
 the ejected milk shows signs of separation. An injection of a lit- 
 tle salt and water, greatly promotes the recovery of the stomach. 
 
 1252. Should the stomach possess too much irritability, the 
 milk will be thrown up unchanged, almost as soon as swallowed, 
 and will not be permitted to tarry sufficiently long to become 
 coagulated, however abundant.the acid may be. In this case, 
 the efforts of the stomach are not so powerfully exerted, and the 
 milk is discharged from the mouth with less force. The child, 
 under such circumstances, should be but seldom nufted, and but 
 for a short period. It should not be suffered to fill its stomach, 
 or it will be sure again immediately to discharge itself. From a 
 quarter to half a drop of laudanum should be given in a little 
 sweetened water, about fifteen minutes before it is nursed, and 
 this three or four times a day. A salt and water injection will 
 also be proper. If it proceed from some peculiarity in the mo- 
 ther's milk, her diet must be changed ; should this not answer, a 
 wet nurse must be procured, or the child weaned. 
 
OF DIARRHCEA. 375 
 
 CHAPTER XXVII. 
 OF DIARRHOEA. 
 
 1253. By this we understand a too frequent discharge of the 
 feculent contents of the bowels, without tenesmus. The great 
 variety of appearance in the matters discharged, has rendered 
 it proper to divide this disease into several species; and, first, 
 
 Sect. I. — The Feculent Diarrhcea. 
 
 1254. Children under two years, or two years and a half old, 
 are especially liable to this complaint. We shall cease to won- 
 der at this, when we recollect the great length, sensibility, and 
 irritability of the stomach and intestinal canal ; the variety of 
 parts with which they powerfully and almost constantly sympa- 
 thize, (as the liver, the skin, the lower extremities, the brain, 
 and the gums,) during teething; and the immense surface they 
 present to be acted upon by acrid or other offensive substances 
 received into them. 
 
 1255. Therefore, whatever is capable of increasing the peri- 
 staltic motion of the bowels, or even, perhaps, a portion of them, 
 may occasion the disease in question; hence, the frequency of 
 this complaint, especially during infancy; since, at that period, 
 the bowels are decidedly more irritable, and many of the re- 
 mote causes are constantly acting. 
 
 1256. This increased action of the bowels, in this species of 
 diarrhoea, may be occasioned both directly and indirectly: — di- 
 rectly, 
 
 1257. 1. By improper or irritating substances being carried 
 mto them; as food of a bad quality; or too much of that which 
 may be good, when taken in improper proportions. This affec- 
 tion may be caused by children receiving into their stomachs a 
 vitiated milk; or food of an irritating kind, as animal substances, 
 either fresh or salt, before the stomach is capable of subduing 
 them; or such as shall undergo a vinous fermentation, as too 
 much sweetening in their victuals, and this permitted to stand 
 until this change is about to take place, before it be given. We 
 have repeatedly known stale food occasion the complaint in 
 
376 OF DIARRHOEA. 
 
 question ; or merely receiving proper food, but in excessive quan- 
 tity. 
 
 1258. In all the instances just supposed, the stomach not being 
 able to digest its contents, the bowels become stimulated by the 
 ill-subdued food urged into them, and make an effort to dislodge 
 it as quickly as possible, by increasing their peristaltic motion; 
 hence, their contents are rapidly and successively transmitted 
 through them, and occasion what is cailed' the feculent diarrhoea. 
 Or, it may be occasioned by the presence of bile in the duode- 
 num; this bile may be either in too great quantity, or it may 
 be highly depraved in its quality; and may, in either condition, 
 so affect the peristaltic motion, as to produce diarrhoea. 
 
 1259. This species of looseness is almost always attended by 
 some nausea, and a little pain; or such sensations as generally 
 attend the exhibition of a cathartic of a stimulating kind, when 
 it is about to commence its operation. This is the most simple 
 form of diarrhoea; and it very often effects its own cure, by the 
 profuseness of its discharge:* but, should it not, a dose of mag- 
 nesia, if there be any evidence of acidity, or castor oil, or rhu- 
 barb, if there be none, will almost always be sufficient for this 
 purpose. Should it not, it may be repeated, but followed by an 
 appropriate dose of laudanum at bed-time, should fever not be 
 considerable. 
 
 1260. We may remark, before we go farther, since the posi- 
 tion is of constant application, that it is not a matter of indiffe- 
 rence what substance we use as a cathartic in any one species 
 of diarrhoea; for success will very often depend upon the proper 
 choice. Thus,' neither castor oil nor rhubarb would be so ef- 
 fectual as magnesia, in that diarrhoea in which the faeces had a 
 predominating acid in them; nor would magnesia be so success- 
 ful as either castor oil, or rhubarb where there was an absence 
 of acidity, as it requires a combination, to a greater or less ex- 
 tent, with such a substance, to render it efficient. 
 
 1261. It may be proper farther to remark, that during the 
 operation of medicine, very little food should be given the child ; 
 and never any of a solid kind. 
 
 * At other times, we may find the attack to be ferocious; being preceded by 
 convulsions, and followed, as soon as sensibility is restored, by considerable pain 
 in the bowels; fever, and this considerable; convulsive startings, &c. This par- 
 ticularly happens with children who have been over or improperly fed, or who 
 possess an usual degree of irritability, or who teethe with much difficulty. 
 
OF DIARRHCEA. 377 
 
 1262. Should there be much nausea, or many efforts to puke, 
 it will always be best to cleanse the stomach ; as these symptoms 
 are almost sure to rise from the presence of a portion of what- 
 ever substance may have been offensive. For this purpose, we 
 have ever found calomel, in proper doses, the best possible re- 
 medy; for it is almost as certain to produce vomiting, under such 
 circumstances, as a medicine absolutely emetic, without the in- 
 convenience of the latter remedy. The calomel, in such cases, 
 had always better be given in divided doses — say, the full dose, 
 divided into three parts, and a portion of it given every hour in 
 a suitable vehicle,* until it effects the intended purpose. 
 
 1263. The doses of calomel proper for the different ages and 
 habits of children are easily ascertained when given, as just sug- 
 gested, in divided doses; as this medicine almost alwaj^s acts 
 with more certainty and promptitude, when thus given, whether 
 its operation be intended to be emetic or cathartic ; and at the 
 same time, no possible risk is incurred, as the child cannot take 
 in this manner an over dose. With the adult, we know that 
 enormous doses are given by some; and this without any addi- 
 tional motive, though, it is said, with a greater certainty of ul- 
 timate effect ; but this does not obtain in the child, where there 
 is so much more irritability of system — and, of course, it must 
 not be taken for a rule. Therefore, should a full dose be esti- 
 mated to be six or eight grains, or even less, it must be divided 
 into three or four portions; one of which should be given every 
 hour, until this quantity be taken, unless the previously exhi- 
 bited parts have operated. And should this fail to have operated 
 as an emetic, we may be pretty certain there is nothing offensive 
 remaining in the stomach, and the calomel will sooner or later 
 pass through the bowels. 
 
 1264. We have made the above remarks, with the hope they 
 may diminish the fears so very often entertained of the violence 
 of this medicine: we can truly say we have never witnessed a 
 
 * It is a matter of consequence, to attend to the vehicle in which calomel is 
 given; its great weight prevents its being suspended in water, or any other 
 equally thin fluid — it must, therefore, be mixed with a drop of sirup, almost of 
 any kind; or, with a very small portion of loaf sugar, and may be thrown dry into 
 the mouth. It is also of much use to attend to the quantity as well as the quality 
 of the vehicle, as much error is committed by employing vastly too much of it. 
 The quantity should be no more than will entangle the calomel. 
 
 48 
 
378 OF DIARRHCEA. 
 
 single instance of over-purging or puking, from this drug. We 
 do not mean, however, to convey the idea, that it cannot hap- 
 pen ; far from it ; for we are sure it might take place, with it, as 
 well as with any other medicine, injudiciously exhibited — we 
 only mean, that too much apprehension is frequently cherished 
 when it is exhibited. Therefore, a grain or two more of calomel 
 to a child beyond six or nine months of age is of no moment, pro- 
 vided this quantity be all the excess. Nor would we say there 
 are not peculiarities of constitution, which would prohibit the 
 use of this medicine. These cases, however, are so very rare 
 as hardly to amount to an exception. But when they occur, 
 they should be strictly attended to. 
 
 1265. This complaint should never be neglected;* especially 
 at such seasons of the year, as are most favourable for its pro- 
 duction ; namely, during the excessive heat of summer, or when 
 the weather becomes cool in the fall"; for when not attended to, 
 it is apt to degenerate into a habit, and to be of extremely diffi- 
 cult removal. 
 
 1266. 2. Indirectly. Diarrhoea may be induced, by the bowels 
 sympathizing with some other part; as with the skin, upon the 
 sudden check of perspiration; the application of cold to the sur- 
 face of the body; or by the improper use of the cold bath. 
 With the brain, from agitation of mind, particularly that of anger 
 or fear ; or with the mere sight of a purgative, which the patient 
 is reluctant to swallow. The latter of these causes, however, 
 cannot be said to operate with children; and are only mentioned 
 to prove the extent to which the bowels may sympathize. 
 
 1267. When diarrhoea is produced by indirect agency, espe- 
 cially cold, it will frequently continue, even after the cause which 
 produced it is removed. This kind is rarely accompanied by 
 pain, unless fever be excited ; in which case the bowels suffer 
 sometimes very much: the skin is often very hot and dry; con- 
 siderable thirst, white tongue, and great fretfulness. There is 
 almost always mucus mixed with the fasces, in such cases. 
 
 1268. This case is treated very much like the former except 
 where pain and fever attend; then castor oil is the best remedy. 
 This should be given in appropriate doses,* every two hours, 
 
 * Castor oil should always be made thin by warming-, before it is given; and it 
 is always easiest to take, when it is not mixed with any other substance. A large 
 tea-spoonful is a dose for a child from one to three months old; a dessert spoonful, 
 
OF DIARRHOEA. 379 
 
 until it operate freely; or until the oil is observed to pass through 
 with the fasces. If considerable pain continue after the opera- 
 tion of the oil, the warm bath may be used most advantageously. 
 If perspiration be excited, the fever will quickly pass, though 
 the tormina of the bowels may remain. Should this be so, an 
 injection, with a proper quantity of laudanum, may be given. 
 This plan of purging, bathing, and giving laudanum, must be 
 continued, as the symptoms may indicate, until the disease 
 ceases. During the whole management of diarrhoea, the strict- 
 est regard shpuld be paid to the diet and drinks of the patient. 
 The former should consist of either of the diluted jellies of rice, 
 tapioca, sago, or arrow root; the latter should consist of thin 
 flaxseed tea, barle^ water, .rice water, gum Arabic water, or 
 an infusion of the slippery elm bark. 
 
 1269. Should the bowels be sympathizing with the gums, the 
 disease will prove more obstinate, and, perhaps, be even con- 
 tinued in a chronic form, especially if the early part of the dis- 
 ease have been neglected, or improperly treated. 
 
 1270. The mouth, under these circumstances, requires atten- 
 tion; for if the teeth give much irritation, the diarrhoea may con- 
 tinue as long as this lasts, however industriously we may address 
 remedies to the bowels. In every case of this disease, where 
 teeth can be suspected of having an agency in its production, the 
 gums should be carefully examined; and, in doing this, the recol- 
 lection of the general order in which the teeth are cut, (See 
 Book I. p. 202, par. 656) will greatly aid in the detection of the 
 irritating teeth — but this order must not be scrupulously relied 
 on ; for the deviations, as already noticed, are considerable. 
 
 1271. Should the gums be swollen, they should be cut down 
 to the teeth, and that freely — but if there be no swelling, or in- 
 flammation in the gums, it would be as unavailing as cruel, to 
 lacerate them. As far as our experience goes, we think we are 
 justified in saying, there is no advantage derived from this ope- 
 ration, when there is no evidence of irritation in the gums from 
 the protruding teeth : though we confess there are many expe- 
 
 for one from three to nine months old; a table-spoonful for one from nine months 
 to eighteen months old. These are, of course, but very general directions, for 
 only such can be given. Increasing, repeating, or diminishing the dose, must 
 be regulated by circumstances; of which almost any body who has charge of 
 children will be a competent judge. 
 
380 OF DIARRHOEA. 
 
 rienced and intelligent practitioners in the habit of performing 
 it. We think we are not deceived, when we say we have never 
 known the slightest advantage from dividing the gums, when 
 there was neither inflammation nor swelling, though the teeth 
 were rapidly making their appearance; for the act of cutting 
 teeth, as we have already said, (674) is not always attended by 
 a sympathizing system. 
 
 1272. We are aware, that many are opposed to the use of lau- 
 danum in the early stages of diarrhoea; but we think they are 
 too indiscriminate in the rejection of this remedy. ,We are Our- 
 selves averse to its administration, where the bowels have not 
 been liberally purged; where there is fever; and where there is 
 no pain ; but where neither the want of due purging nor fever, 
 make a contradiction, we almost always give a small quantity 
 at night, and especially if the child be very restless, or in pain. 
 We are persuaded we very much abridge this complaint by this 
 plan, and almost certainly prevent its running into a chronic 
 form, after we have removed, as far as in our power, the ex- 
 citing causes of the disease. 
 
 1273. During the continuance of this disease, we strictly for- 
 bid animal food or juices, under any form.* If the child be at 
 
 * We were not a little surprised to find the following observation from Dr. 
 Cheyne, on the subject of proper diet for children; namely, that "an animal diet 
 produces less irritation than one which is solely composed of vegetable matter," p. 
 36. It is certainly contrary to cur own experience, and, we had almost said, to 
 that of every body else. We have ever found reduced milk, rennet whey, gum 
 Arabic water, thin sago, tapioca, or arrow root, vastly more proper in all the 
 complaints of the bowels, where nourishment may safely be permitted, than any 
 animal juice, however much diluted. But we are persuaded that during the 
 acute form of the disease, where purging is necessary, where there is pain, and 
 fever, the less of any thing the child takes into its stomach the better. For at 
 this time the condition of the system is such, as not to require nourishment; for 
 who wants "to feed a fever," or who ever knew pain arising from irritation, or, 
 perhaps, inflammation of the bowels, relieved by cramming the child with food? 
 The only proper thing, at such times, is a little of the mother's milk, if the child 
 be not weaned, or if weaned, milk and water, if milk be known to agree with it; 
 or the occasional use of thin gum Arabic water. 
 
 Besides, we would ask, of what possible use can nourishment be at this time; 
 since, from the deranged and irritated way, oftentimes, of the inflamed state of 
 the stomach, and duodenum, healthy or perfect digestion cannot be performed; 
 and if it cannot, that which has been received, and not properly subdued by the 
 stomach and duodenum, is an extraneous substance to these parts, and acts like 
 one, by keeping up irritation. 
 
OF DlARRHCEA. 381 
 
 the breast, let it be confined to it, if the mother have a sufficient 
 supply ; if she have not, let it be in part supported by reduced 
 milk, and a little sugar. Its drinks may be very thin milk and 
 water, barley, or rice water, or, simply, water, if it refuse those 
 just mentioned. No solid food whatever should be given during 
 the existence of this complaint; and every kind of liquor, whe- 
 ther fermented or distilled, should be peremptorily forbidden, 
 The child should be more warmly clad than usual, unless the 
 weather be very warm. But its feet should be covered with 
 socks or shoes, both by day and by night. If the weather be 
 not excessively hot, but especially if it be cool, the legs must be 
 kept enveloped in woollen stockings, and its body in flannel; 
 provided the disease be not in its active state, and accompa- 
 nied by fever and a hot skin, and these parts not cold. 
 
 1274. The greatest care should be taken, that, through a 
 mistaken kindness, the child do not receive articles every way 
 aggravating to the disease — such as fruits, (see Book I. p. 222,) 
 meats, preserves, raisins, &c. ; and that it be not suffered to 
 swallow the hundred infallible cures promulgated by newspa- 
 pers, or recommended by officious and visiting gossips. 
 
 1275. The child should not be permitted to sit on a damp or 
 cold place; as stone or marble steps, pavement, &c; nor placed 
 so as to receive a draught of air, especially if its skin be dis- 
 posed to moisture. 
 
 Sect. II. — 2. Of the Bilious Diarrhoza. 
 
 1276. In these species, the fasces are loose, copious, and of a 
 bright yellow or green; and the bowels are stimulated to in- 
 ordinate action, by an overcharge of bile, either vitiated or not. 
 This complaint is very frequent among our children during the 
 heat of our summers, or as the fall approaches. The influence 
 of a hot sun upon the action of the liver, is well known to every 
 body ; it is familiar to common observation, that after a spell of 
 very warm weather, even the healthy evacuations of the adult 
 give evidence of its rapid formation, and sometimes of its abun- 
 dant absorption. Thus, the fasces are observed to be loaded 
 with bile; and the urine to be deeply tinged with it; and when 
 the complaint, of which we are treating, seizes upon children, 
 it is called " the summer complaint." 
 
382 OF DIARRHOEA. 
 
 1277. If the adult system, then, can be so inflamed by ex- 
 cessive heat, we need not be surprised that infants should suf- 
 fer under the same power: and this, very often, independently 
 of the most of the remote causes enumerated under the first 
 species. (1257.) 
 
 1278. During our summers, the action of heat is both uniform 
 and excessive : the liver feels its influence, and is forced to an 
 inordinate secretion of bile, which, being suddenly and rapidly 
 poured into the bowels, stimulates them to -excessive action, ei- 
 ther by quantity or quality, or both, and thus the bilious diar- 
 
 > rhcea is produced. 
 
 1279. This action of the bowels, as in the species just consi- 
 dered, sometimes relieves them of their stimulating contents, 
 and will thus effect its own cure— hence, this species, like the 
 other, may be ephemeral; and not be more formidable than the 
 feculent species, unless the formation of bile goes on almost in- 
 definitely, or fever be provoked. 
 
 1280. No period of infancy is free from attacks of this kind; 
 and especially in summer, or early in the fall. We have seen 
 extensive bilious evacuations from children of ten days old; and 
 from this time to every period of childhood, they are obnoxious 
 to them. 
 
 1281. We believe teething very rarely occasions this com- 
 plaint, though it may very much aggravate the general symp- 
 toms by increasing the natural irritability of the system, and 
 thus give rise to fever. Should fever take place, the disease 
 becomes more formidable; not because the discharges from the 
 bowels may be increased, but because fever in itself, under all 
 modifications, is formidable. 
 
 1282. The plan of treating this form of diarrhoea, will sugr 
 gest itself; the bowels must be evacuated of their contents; and 
 that by the remedy which so decidedly and successfully exerts a 
 control over the actions of the liver; namely, calomel, in small 
 but repeated doses, until, from the change in the appearance of 
 the evacuatioriSj it is judged the purging has been carried suffi- 
 ciently far; that is, when a little of the mucus of the bowels, or 
 small coagula of milk show themselves. 
 
 1283. At night, in the absence of fever, the motion of the 
 bowels should be tranquillized by a proper dose of laudanum* — 
 
 * The proper dose of laudanum for infants and children, may be reckoned at 
 
 
OF DIARRHCEA. 383 
 
 preferably by injection, if practicable; if not, it must be given 
 by the mouth. Should this complaint reappear the next day, 
 the calomel may be repeated, but at longer intervals, and only 
 sufficient to procure a decided evacuation : this should again be 
 followed by the anodyne, and so on, until the disease disappear. 
 
 1284. The diet and drinks should be the same as before re- 
 commended ; (1273) except that rennet whey answers, both as 
 nourishment and drink, an admirable purpose in this species of 
 diarrhoea. 
 
 1285. If fever attend, it will require more purging than if it 
 be absent ; but, after the bowels have been properly evacuated 
 by the calomel in the beginning, castor oil should be used; or, if 
 there be evidence of acidity, that is greenish or hard, small coa- 
 gula of milk, magnesia, or magnesia and rhubarb are the prefe- 
 rable laxatives. The occasional use of the warm bath will also 
 be proper. Much advantage is found in giving very minute 
 doses of the tartrite of antimony every two hours in this condi- 
 tion of the system* — it maintains the action of the bowels, and 
 very much abates the force of the arterial system. Should the 
 small quantity given, produce puking, give but half the quantity 
 until the stomach will bear a fuller dose, unless the bile be thrown 
 up from the stomach — if so, encourage the discharge. 
 
 1286. Mr. Burns says, "During the whole course of the dis- 
 ease, it is proper to support the strength with light nourishment, 
 such as beef tea, arrow-root jelly, toasted flour boiled with milk, 
 &c." " The strength should be supported by small quantities of 
 white wine whey, given frequently." (Vol. II. p. 195.) 
 
 the following rates. Haifa drop for a child under ten days old? a drop for one 
 from that period, to the end of the month: a drop and a half, or two drops for 
 one from that period, to three months; three drops from this time to nine months; 
 four drops from nine months to eighteen; five or six drops from that time to 
 three years — then, for every succeeding 1 ' year, a drop or two may be added. 
 These doses are prescribed for children who are altogether unused to this drug; 
 the power of bearing more, maybe rapidly increased by habit. In giving direc- 
 tions for the use of laudanum, we should always understand the habit of the 
 child in this particular, and regulate the prescription accordingly. When lau- 
 danum, is to be used as an injection, we may safely increase the quantity three 
 or four fold. 
 
 * By small doses of the tartrite of antimony, we mean from the tenth or twelfth 
 to the twenty-fourth part of a grain. It should be carefully dissolved in its pro- 
 per or intended quantity of water, which should be accurately measured, the 
 spoon by which the water was measured should be the one to give it from. 
 
384 OF DIARRHffiA. 
 
 1287. This advice must be taken with considerable caution, 
 especially in using the beef tea, and the wine whey; as Mr. Burns 
 himself admits that fever attends this complaint, and, that there 
 is much intestinal irritation. In every disease, almost, there is 
 too much anxiety expressed,' for the strength of the patient; it 
 does not seem to be recollected, that the patient and the dis- 
 ease, are a unit; and when you attempt to strengthen the one, 
 you run the risk of increasing the other; especially if this be 
 done with stimulating articles of diet. It should also be recol- 
 lected, that debility is not disease — remove the disease, and you 
 will rarely have trouble with the debility. Besides, where it is 
 confessed there is much debility, it is never best removed by 
 stimulants alone, unless every article of diet, however bland, or 
 entirely vegetable, be considered as such. 
 
 1288. Brown considers every thing as stimulants; and he di- 
 vides them into two general classes : viz. the durable, as food 
 of every kind; and the diffusible, as alcohol, in aril its varied 
 modifications, as brandy, wine, porter, &c. ■ Therefore, agree- 
 ably to this scheme, every thing taken as diet, must be stimu- 
 lating: let this be admitted; if it will be conceded at the same 
 time, that they differ not only in force, but in their modes of ac- 
 tion; that they differ in possessing, from the smallest to the 
 greatest power ; and that the force or power of the stimulant 
 should be accurately proportioued to the state of the system. 
 We will then say, agreeably to this arrangement, that eacf ar- 
 ticle of food, or of drink, must be considered as a stimulant of 
 a given power, and come under one of the classes just named; 
 durable or diffusible. But, on the other hand, it must be grant- 
 ed, that the true art of curing diseases consists in the regulation 
 of stimuli, to the force of disease, or rather, to the susceptibili- 
 ties of the system to be acted upon. 
 
 1289. If this be true, and we believe it will not be disputed, 
 the use of beef tea, a highly stimulating article, of the durable 
 kind, and the wine whey, another, though not a very powerful 
 one, of the diffusible kind, are decidedly improper in affections 
 of the bowels, where fever and local inflammation exist, as they 
 do, perhaps, in almost every case of diarrhoea. 
 
 1290. It may be said Mr. Burns does not recommend them, 
 where there is fever — he does not expressly; but he tells us, 
 that " during the whole course of the disease, it is proper to 
 
OF DIARRHOEA. 385 
 
 >rt the strength with light nourishment; such as beef tea, 
 &c.;" and " by small quantities of white wine whey, given fre- 
 quently.'" (loc. cit.) Now, what are we to understand by the 
 whole course of the disease, but from its commencement to its 
 termination ? and fever, which he admits to accompany this dis- 
 ease, at least sometimes, can have existence but during some 
 one part, or the : of this period; therefore, the wine whey, 
 
 and beef tea, must be given when fever is present ; since it is, 
 agreeably to Mr". Burns, " proper to support the strength, during 
 the whole course of the disease." 
 
 1291. If we can place any reliance upon the accuracy of our 
 own observations, we can with much safety declare, that beef 
 tea, or any other diluted animal extract, has uniformly been at- 
 tended with bad consequences, in the commencement of almost 
 all affections of the bowels ; and this from a twofold action: 1st, 
 it is too stimulating when applied to the surface of the irritated 
 bowels; and, 2diy, in affording too much nourishment, for the fe- 
 brile condition of the system. The wine whey, though a novel 
 remedy to us in acute bowel complaints, is still more exception- 
 able, from its mode of action, than even the beef tea ; there- 
 fore we should forbid if ; as we make it a first and positive di- 
 rection, that no animal substance of any kind, or in any form, 
 shall be given' in diarrhoea, even in its most simple form, when 
 attended with bilious discharges ; and we as positively prohibit 
 liquor of every sort. We have none of those over-weening ap- 
 prehensions for the strength of our little patients, that w r ould 
 lead us to cram them with nourish ment ; consequently, w T e make 
 very little n lor their support : believing the first object 
 
 is to free them from disease, by the most prompt and efficacious 
 means in our power ; and until we do this, in acute diseases, we 
 
 1 
 
 )ermit strength to take care of itself. 
 
 1292. But we must not be understood to forbid all nutritious 
 substances to the child ; this we do not do ; but we are very par- 
 ticular, both as regards quantity and quality, when nourishment 
 is permitted. The other articles enumerated by Mr. B., (arrow 
 root, boiled flour, &c.) we employ, occasionally, in small quan- 
 tities, as well as rice water, barley water, gum Arabic water, 
 thin sago, and tapioca; and rennet rclicy, during the period of 
 purging, if the child be weaned ; bul if it be not, we confine ii 
 
 49 
 
386 OF DIARRH(EA. 
 
 to the breast for nourishment,* and to barley, or rice-water for 
 drink* 
 
 1293. It may be proper to observe, that, in the species of diar- 
 rhoea we are now considering, we have not made, as some have, 
 (Good, &c.) yellowness of the evacuations essential to it — we 
 very often see them of various shades of green, from the bright 
 grass green, to the bottle, or almost black green ; this is some- 
 times accompanied by a frothy top, or the whole mass looking 
 spongy, resembling very much the green production on the top 
 of stagnant water ; at other times, it is of pitchy darkness and 
 tenacity. Where this last is observed, it has always been pre- 
 ceded by a pretty obstinate fever, which does not usually yield, 
 until these black evacuations come away. 
 
 1294. The bile, beside several other purposes, is supposed to 
 neutralize the acid formed in the stomach ; and when this, as 
 well as the bile, is abundant, it may give a tone of green to the 
 evacuations. This use of the bile must necessarily be important 
 in infancy, where there is so strong a tendency to generate acid ; 
 or for the ingesta to become so, by tarrying long in the stomach 
 and bowels. Where, then, the bile is deficient in quantity, or 
 the acid more than usually abundant, we have not only green 
 stools, but oftentimes very frequent ones; owing, doubtless, to 
 the presence of so much loose acid coming in contact with the 
 mucous coat of the intestines ; hence the utility of absorbents in 
 such cases, and the almost immediate cessation of diarrhoea after 
 their exhibition, if they be purely absorbents,! as the prepared 
 chalk, oyster-shells, &c. But as absorbents can only be given 
 with advantage, where there is an excess of acid, they should be 
 given with much caution, where this is not satisfactorily proved 
 to exist : ; especially where there is febrile irritation attending 
 
 * We even limit this sometimes; especially where there is much fever, or when 
 there are many milk coagula discharged. In such cases, we permit the child to 
 be seldom nursed, and then the above nourishment to be given in but small quan- 
 tities. 
 
 j- We say, purely absorbents; by this, we mean where the union with an alka- 
 line earth will not form a purgative compound — thus, when the carbonate of lime, 
 as in chalk, meets with an acid, the tertium quid will not be purgative. But 
 should we give magnesia, confessedly an absorbent, the union of the acid with 
 it improves its cathartic qualities; and of this we often take advantage, in certain 
 conditions of the bowels. Hence, the risk which is sometimes incurred by the 
 incautious use of the "cretaceous mixture," as suggested, (1295) by immediate- 
 ly putting a stop to the motion of the bowels. 
 
OF DIARRHCEA, 387 
 
 the diarrhoea, as almost always happens when this complaint 
 arises from teething. 
 
 1295. Much injury has been sustained by mistaking green 
 bile for acidity, and administering the cretaceous mixtures: au- 
 thors abound with cases of cholera, convulsions, fever, &c, 
 arising from this cause. It, therefore, becomes very important 
 that the one should not be mistaken for the other. But we 
 shall have occasion to revert to this subject presentlv. 
 
 1296. Where a bilious diarrhoea has continued for some time, 
 either from the force of the remote cause, neglect, or ill treat- 
 ment, and has been attended pretty uniformly by green and slimy 
 stools,* we have often the satisfaction of seeing them speedily 
 change to a bright yellow 7 : this change in the appearance of the 
 discharges, is almost a certain sign that the disease is about to 
 yield. This has been effected, by ordering a proper regimen ; 
 regulating the heat of the body; covering the limbs with woollen 
 stockings ; applying flannel to the abdomen ; prohibiting improper 
 drinks ; withholding " infallible remedies ;" lancing the gums ; by 
 the use of small doses of calomel, and the occasional exhibition 
 of laudanum, either by the mouth, or by enemata. 
 
 1297. In this stage of the complaint, we are sometimes aided 
 very much by giving lime-water and milk, in equal portions,t se- 
 veral times a day; or sometimes by having their milk diluted with 
 it instead of common water, where the child is either weaned, or 
 is obliged to be supported, in part, by artificial means. 
 
 Sect. III. — Mucous Diarrhoea, 
 
 1298. The evacuations consisting of, or containing, a copious 
 discharge of mucus. This species is commonly produced by a 
 sudden check of perspiration, or the sudden application of cold 
 to the surface of the body and the feet, especially in adults. We 
 have seen it follow, in two instances, in children, the improper 
 
 * By slime, we do not mean the mucous secretion of the bowels, which is 
 white or whitish, tinged with a little blood; but a tenacious bile itself of a green 
 colour, though not, perhaps, so intense as the general substance of the evacua- 
 tion. 
 
 \ The dose of lime-water and milk, may be a tea-spoonful of each, every hour 
 or two for children under six months; double this quantity, or even more, for 
 older children. 
 
388 OF DIARRHCEA. 
 
 use of the cold bath. Children have been seized with this .corn- 
 plaint from the sudden transitions of the atmosphere, where they 
 have not been properly protected. This species is, perhaps, the 
 only one in which the teething of children have not been accused 
 of an agency. 
 
 1299. The discharges in this complaint are not so frequent, 
 by any means, as in the species we have just been considering. 
 There is sometimes a little forcing or tenesmus, and occasionally 
 a little blood. The faeces are, for the most part, of a light 
 green, and not very abundant, unless procured by medicine; 
 then, oftentimes, they are very copious, and offensive. A little 
 mucus always precedes the feculent matter, and is almost sure 
 to be followed by it. For the first few days, {he mucus resembles 
 that yielded by the nose in catarrh ; after this, it becomes thicker, 
 less transparent, and in a short time more purulent; and when 
 purulent in its appearance, it is almost always found to be 
 streaked with a little blood. This change is generally favoura- 
 ble, and bears a strong analogy to what takes place with catarrh, 
 when about to get well. It, therefore, rarely requires any thing- 
 more than persisting in the demulcent food and drinks recom- 
 mended above. Unless the stools now become numerous, thin, 
 and very yellow or green; in this case, a little rhubarb tea,* 
 with very minute doses of laudanum, will be found to answer 
 admirably well; but the mucilaginous drinks must be constantly 
 persisted in. 
 
 1300. Fever rarely accompanies this complaint, in its milder 
 forms; and it is of easy management, in general, with children; 
 but, in adults, we have known it very obstinate. The remote 
 cause should not be repeated, if it proceed from cold bathing; 
 and removed, or its operation prevented, if from cold, by addi- 
 tional clothing, &c. 
 
 1301. The bowels should be gently purged by castor oil, and 
 its operation followed in the evening by a suitable dose of lauda- 
 num. This plan must be pursued daily, until the bowels be re- 
 lieved ; or they may be purged by rhubarb and magnesia during 
 the day, and followed, as before directed, by an anodyne in the 
 evening. The diet should consist of such articles as have been 
 
 * Rhubarb tea; take half a dram of bruised rhubarb — pour on it a wine-glass- 
 ful of boiling water — let it stand until cool— strain, and add a little loaf sugar to 
 it. A tea-spoonful every two hours should be given, until it colours the stools. 
 
OF DIARRHCEA. 389 
 
 already directed ; and the patient take freely of an infusion of 
 slippery elm bark, or gum Arabic water. 
 
 1302. Dr. Good condemns the use of purgatives, in this species 
 of diarrhoea ; but upon no good ground, that we can perceive — 
 our experience is decidedly in favour of the plan just proposed; 
 that is, mild doses of castor oil, or gentle doses of rhubarb and 
 magnesia in the beginning of (he disease. If, by purgatives, Dr. 
 G. mean no more than laxatives, we would agree with him. He 
 would certainly give laxatives in d} r sentery, so as to procure 
 one or two faecal evacuations per diem, to which it bears some 
 analogy, as far as regards effects, and appearances: only in the 
 mucous diarrhoea, there is, in general, no vascular excitement, 
 and, therefore, most probably, no inflammation, though certainly 
 irritation ; whereas, in dysentery, more or less inflammation al- 
 ways attends. 
 
 1303. Dr. Good, and others, recommend in this affection, or 
 in any " other looseness produced by a sudden chill upon the 
 surface, small doses of ipecacuanha, with or without opium." 
 We have used this prescription at night, and, we think, with 
 evident advantage; but it should not be given in the clay, unless 
 there be considerable pain ; and then only after an evacuation of 
 fasces has been procured. 
 
 Sect. IV. — Chylous Dicirrlwu. 
 
 1304. This form consists of chylous or milky evacuations. It 
 would appear that there is a deficiency of bile in this disease, as 
 the dejections are not tinged with this substance — consequently, 
 this complaint would seem to be necessarily accompanied by 
 some derangement of the hepatic system, either positively or ac- 
 cidentally. The liver may not be in a condition to secrete this 
 fluid abundantly, or its flow into the intestines, may, by some 
 means or other, be impeded. 
 
 1305. We are inclined to believe in the first, rather than in 
 the second condition of tire liver ; since we have never witnessed, 
 that we recollect, this complaint being attended by jaundice. 
 But why the lacteals should refuse to take up the chyle after it 
 is formed, is very difficult to say, yet we know there is a strong 
 consent between the liver and the lacteals; as emaciation takes 
 place very rapidly, when that vise us is much deranged: or, the 
 
390 OF DIARRHCEA. 
 
 lacteals may, like the intestines themselves, require the presence 
 of a certain quantity of bile, to be healthfully stimulated. 
 
 1306. Do the lacteals really refuse this fluid? — or is it only 
 supposed they do not absorb any, because they do not take up 
 the whole 1 Would this want of absorption really prove an in- 
 capacity to do so? May not the fluid ejected from the bowels be 
 very far from a well concocted chyle? — and may it not, in con- 
 sequence of this, lack the appropriate quality to stimulate them 
 to the act of absorption ? 
 
 1307. We have seen this complaint make its appearance sud- 
 denly in children, after weaning; and we have seen it make its 
 approach gradually, after a pretty long continuance of bilious 
 diarrhoea. In both these cases, we have supposed the digestive 
 organs, particularly the duodenum, to be in fault, rather than 
 the lacteals, or mesenteric glands. We have believed that the 
 product of digestion has been ill elaborated, as well as too 
 speedily passed through the bowels. The appearance of the 
 dejections would seem to prove the first ; and its quantity and 
 fluidity, to countenance the second. 
 
 1308. In consequence of ill elaboration, the chyme must pos- 
 sess new or unusual properties: possessing new properties, it 
 would be likely to act upon the susceptible bowels, almost as a 
 foreign substance; and they would in consequence, be urged to 
 an increased peristaltic motion ; or become passive, by not being 
 duly stimulated. And the absence of bile may be adduced in 
 support of the belief of this absence of a certain quality in the 
 chyme; since the extremity of its duct is not properly stimulated 
 to pour it out. 
 
 1309. When a child is seized with this complaint, it very ra- 
 pidly becomes weak, and emaciates with surprising suddenness, 
 and, if not relieved pretty soon, it becomes exhausted for want 
 of nourishment. 
 
 1310. In treating this complaint, whether it be suddenly in- 
 duced, or it follow a diarrhoea, we have always prescribed for 
 the condition of the stomach ; and we may safely say, we have 
 generally succeeded. We should withhold almost all food from 
 the stomach, that its weakened powers need not be longer over- 
 taxed. We, therefore, confine the child to small quantities at a 
 time, of rennet whey, or gum Arabic water : nothing else is permit- 
 ted. We endeavour to restrain the passages, by an anodvne in- 
 
OF DIARRHCEA. 391 
 
 jection of full power, at night ; and give, during the day, minute 
 doses of calomel — say, a quarter-grain every four hours, with the 
 twentieth of a grain of opium. We persevere in this treatment 
 for a few days, unless the calomel urge the bowels too much — in 
 this case, we diminish the quantity of the calomel, and increase 
 that of the opium. We have thought we have derived advan- 
 tage from the application of a blister to the back of the neck, 
 and keeping the whole body unusually warm. 
 
 1311. We have seen the most decided relief from this plan; 
 and giving the stomach very little to do, it becomes reconciled 
 to its duties, and fulfils* them after a little while, perfectly. 
 
 1312. Query : would small quantities of bile, exhibited in some 
 form or other> be useful in this complaint? 
 
 Sect. V. — Lienteric Diarrhcea. 
 
 1313. "The rapid passage of the nearly unchanged aliment 
 through the bowels, constitutes this species of diarrhcea." With 
 children, it sometimes follows the other species of diarrhcea, but, 
 perhaps, oftener, dysentery. It is not accompanied by much 
 acute pain; though the child appears uneasy after eating; and is 
 immediately relieved by an evacuation taking place, which is 
 perceived to consist of the food taken into the stomach a little 
 while previously. This complaint rarely comes on suddenly; 
 and it may exist ia different degrees. When a tendency to this 
 complaint is first perceived, it should be instantly attended to; 
 for it is one of those affections, that rarely, if ever, cures itself. 
 
 1314. It, generally, commences during the chronic state of 
 diarrhcea, by showing, perhaps, that some one article of diet 
 only, has passed the bowels unchanged, as potato, apple, or other 
 vegetable substance, or fruit, which has been incautiously given 
 to the child. This is pretty soon followed by other articles, as 
 meat, &c; and, finally, every thing, almost, that enters the sto- 
 mach, is speedily conveyed through the intestines, with little or 
 no appearance of having been acted upon by the powers of the 
 stomach. The appetite is, sometimes, voracious in this disease, 
 and the thirst is always considerable. 
 
 1315. Dr. Good declares, " the bile, as in the case of chylous 
 diarrhcea, is not duly secreted, or is obstructed in its passage; 
 for, were there a free flux of bile, the faeces, however crude and 
 unconcocted, would display their common hue, which they rarely 
 
392 • OFJHARRHCEA. 
 
 exhibit" This is not altogether accordant with our experience ; 
 we have rarely, if ever, failed to see bile in a greater or less de- 
 gree accompany the lienteric discharges, and, sometimes, we 
 have seen the food imbedded in a quantity of pure bile. That 
 the functions of the liver may be impaired or vitiated in this com- 
 plaint, we have no hesitation to believe ; but that the secretion 
 stops altogether, or that its passage is obstructed, as a common 
 event, we cannot accede to ; at least, when it happens with chil- 
 dren; and we confess ourselves not to be familiar with it in adults. 
 
 1316. If no bile were secreted, none could appear in the stools; 
 but Dr. Good seems to confess there is, occasionally, the pre- 
 sence of bile in them, though he says, they " rarely exhibit" it. 
 We, on the contrary, say we do not recollect an instance in 
 which there was a total absence, of this important fluid in the 
 stools. It may readily, pass unobserved, if it be not looked for; 
 since the frequency of stools is sometimes so great, as to attach 
 but little bile in their course. There cannot be an obstruction 
 to its flow, as there are no signs of jaundice. 
 
 1317. This complaint seems to be seated altogether in the sto- 
 mach itself, and owes its existence to the too great irritability of 
 this organ ; for no sooner is food lodged in it, than it makes ef- 
 forts by an increased peristaltic action to discharge it ; and the 
 intestines transmit it with equal speed to their extremity, there 
 to be discharged. Dr. Good suggests, that " the gastric juice 
 may not be secreted in proper quantity or with proper qualities :" 
 this may be ; but it is not sufficient to account for the phenome- 
 non ; for this happens precisely in dyspepsia, but dyspepsia is 
 not attended with Iientery. 
 
 1318. We have been in the habit of treating this disease very 
 much after the manner of " chylous diarrhoea," to which it has 
 a very strong resemblance, in the rapidity with which the food is 
 passed through the tract of the intestinal canal ; and would seem 
 to be but an excess of it ; in the one, the stomach digests to a 
 certain extent, but confessedly imperfectly : as the ill-concocted 
 mass is hurried from the stomach into the intestines before it 
 can be properly elaborated. In the disease in question, it tarries 
 a still shorter time ; and, for the most part, passes with little or 
 no change. Our plan of treating this complaint will be better 
 understood by relating one of a number of cases which have 
 fallen under our notice. 
 
OF DIARRHOEA. 393 
 
 1319. The daughter of L. A., aged ten months, had a pretty 
 serious attack of bilious diarrhoea, in consequence of her teeth 
 passing with difficulty through the gums. She was, however, 
 relieved of this, by small doses of calomel, the occasional use of 
 laudanum, and by cutting the gums. Being an only child, and 
 a great pet, especially with two or three aunts who were doomed 
 to "single blessedness," she was too early indulged in improper 
 articles of food, though she was ordered to be confined to the 
 milk of her mother. fc She was permitted to taste of every thing 
 she craved, though several of these articles were observed to pass 
 the bowels unchanged — among these w r ere portions of Irish, and 
 sweet potatoes, and raisins. This gave no alarm to the loving 
 aunts, or to the inexperienced mother; and she was permitted 
 for awhile longer to gratify her capricious desires, until the 
 stomach lost control over everything received in it; and, of 
 course, its contents were transported through the bowels un- 
 changed. We were now again sent for. 
 
 1320. There was neither nausea nor vomiting in this case; 
 but the thirst was great; the urine small in quantity ; high-co- 
 loured, and of a very strong smell. The child began to fall 
 away, and its strength to decline rapidly. We ordered that no 
 kind of food whatever should be given, save that of the milk of 
 the mother, and that only once in four hours, and then not in 
 full quantity. Should the thirst require more fluid than the 
 milk, to satisfy it, by giving from time to time a tea-spoonful of 
 cold water. To put woollen stockings on its legs; flannel it was 
 already wearing on its body. To have the abdomen rubbed 
 three or four times a day, for ten minutes at a time, with the 
 bare warm hand. To not awake the child when asleep, under 
 any pretence whatever. To have her taken across the river in 
 the steam-boat two or three times in the afternoon, when the* 
 weather was suitable. 
 
 1321. In addition to this, she was to take four drops of chaly- 
 beate wine, and a quarter drop of laudanum every two hours, 
 in a few drops of sweetened water, when awake. This plan was 
 pursued for two or three days before any change was perceived ; 
 but, at the end of this time, it was observed, that the food re- 
 mained rather longer in the stomach after nursing, though the 
 milk seemed to pass off unchanged, with some small tinges of 
 brighter yellow than before. 
 
 50 
 
394 OF DIARRHOEA. 
 
 1322. Thinking advantage might be derived from stimulating 
 the external surface of the abdomen more powerfully than by 
 the frictions of the hand, we ordered the tartar emetic ointment 
 in the 'proportion of a dram of the tartrite, to an ounce of simple 
 cerate; a portion of this to be applied once a day over the whole 
 surface. The-quantity of laudanum was increased to half a drop, 
 every two hours; the nursing, drink and exercise, as before. 
 
 1323. At the expiration of three more days, the discharges 
 from the bowels were less frequent; the milk was perceived to 
 be slightly curdled ;* the bile more evident, the urine rather more 
 abundant, and the skin of a more uniform and natural warmth. 
 The ointment had produced no effect upon the skin; it was or- 
 dered to be rubbed twice a day— no increase of nourishment, 
 and the same drink. 
 
 1324. At the end of three more days the stools had become 
 less frequent ; they bore evident marks of digestion, and were as- 
 suming a more decided tone of yellow. The skin was beginning 
 to show signs of irritation: the ointment continued; the lauda- 
 num increased to three-fourths of a drop, the nursing, drink, and 
 exercise, to be continued as before. 
 
 1325. At the expiration of another period of three days, we 
 found every thing much changed for the better — had had but 
 two evacuations for the last twenty-four hours — digestion much 
 more decided ; stronger evidences of bile ; the urine much freer, 
 lighter coloured, and less rank in smell. The skin of the abdo- 
 men pretty much irritated. The laudanum was not increased; 
 the nursing was permitted to be a little more in quantity, but 
 not oftener; the water was now sweetened with a little loaf- 
 sugar, as the thirst was considerably abated. 
 
 1326. Another interval of three days had passed. One stool 
 only per diem, but it was large 1 ; some portions of white curd 
 mixed with the new yellow faeces — faeces pretty offensive ; urine 
 sufficiently abundant; the abdomen much irritated ; the skin and 
 pulse natural. It may be well 1 to observe, that the pulse was 
 little or none affected during the whole time, on which account 
 we did not notice it hitherto in our reports. 
 
 1327. As the mother's milk was sufficient in quantity, as well 
 
 * In some cases, there appears to be an excess of aci<l; and the milk passes 
 through in the form of whey and coagulum. 
 
OF DIARRHCEA. 395 
 
 as good in quality, we ordered the child to be exclusively con- 
 fined to it — but that it might be nursed rather more frequently, 
 to permit the vesications on the abdomen to heal gradually; to 
 continue the laudanum, but much less frequently, say three or 
 four times a day; and, should the bowels now become rather 
 confined, of which, of course, there was a risk, to have them 
 opened by ah injection of molasses and water. 
 
 1328. The child was now ordered to the country, from which 
 it returned, in about three weeks, in perfect health. 
 
 1329. We have found this disease, generally speaking, to be 
 a manageable one, when sufficiently early attended to; but when 
 suffered to run on to the last stage of debility, little or nothing 
 can be done. Or, when it occurs in the adult, it but too gene- 
 rally proves fatal, as it, for the most part, takes place in feeble 
 and worn out constitutions, from hot climates, after chronic dy- 
 sentery, or diarrhoea. 
 
 1330. There are several more varieties of diarrhoea, but of 
 which we have never seen cases ; and, consequently, can say no- 
 thing from our own experience; nor has the experience of others 
 discovered any certain method of cure. Besides, they appear 
 to belong exclusively to the adult — at least, we have never wit- 
 nessed them in children ; such are diarrhoea serosa, tubularis, 
 and gypsata. 
 
 1331. In our account of the several diarrhoeas which we have 
 just passed, our histories, and the method of cure, have reference 
 principally to their acute or sub-acute stages. We shall now 
 occupy a few minutes upon these diseases, when they have as- 
 sumed a chronic form. But it may be proper to observe, it is 
 not necessary to keep up the distinction of species: as they ap- 
 pear to merge into one common form of disease, after they be- 
 come chronic. 
 
 1332. Thus, the feculent, the bilious, and the mucous, may 
 become chronic, and require but little if any variation of treat- 
 ment. This, especially, happens when these diseases are ne- 
 glected, about the period of teething and weaning. Several 
 writers have described this disease, as De Salle, Cruveilhier, 
 Hamilton, &c. ; but none so well as Dr. Cheyne. Mons. Andral 
 has been very attentive to the chronic form of diarrhoea, and 
 has made many post mortem examinations; they agree very 
 much with those of Dr. Cheyne, as regards the state of the mu- 
 cous membrane, and of the intestines themselves. 
 
396 OF DIARRHffiA. 
 
 Sect. VI. — Of the Chronic Form of the Diarrhoea of Infants, 
 
 1333. We have said, that several of the species of diarrhoea 
 already treated of, may be made to nm into a. chronic form, of 
 very difficult management, as well as of great danger; 1st, by 
 neglect; 2dly, by the continuance of the remote and exciting 
 causes; or, 3dly,by impropertreatment: thus, those children who 
 have been too early weaned, improperly fed after weaning, or 
 separated from the breast at an improper time, are more obnox- 
 ious to it than those who have been more properly managed. 
 
 1334. The form of the disease which we are about to describe 
 occurs sufficiently often in this country, to make it formidable; 
 but is of much more frequent occurrence in Europe. It would 
 seem, also, to be more common in one portion of country, than 
 in another; thus, in Scotland, agreeably to Dr. Cheyne, it-is a 
 disease of frequent occurrence; less so in England; and in 
 France, according to De Salle, it was considered an epidemic. 
 There the disease acquired the name of "Maladie de Cruveil- 
 hier," because this physician first described it there, though it 
 is essentially the same, as that so well detailed by Dr. Cheyne, 
 under the name of " Atrophia ablactatorum," or " weaning 
 brash." 
 
 1335. We have just hinted, that the u Atrophia ablactatorum," 
 or "weaning brash," was nothing more than the chronic form 
 of the several species of diarrhoea, to which infancy is liable. 
 And though this complaint is confessedly more common, at the 
 period of weaning, or immediately after the child is separated 
 from the breast, it may occur at other periods, and from other 
 causes. Every diarrhoea, after it has continued from fourteen 
 to sixteen days, may be considered as chronic ; therefore, the 
 disease so ably treated of by Dr. Cheyne, must be considered 
 only as a perseverance of the common diarrhoea of children, 
 during summer and fall, and not a new or distinct disease. This 
 is confirmed, we think, by the phenomena, the causes, the mode 
 of treatment, and the post mortem examination. For even the 
 feculent diarrhoea, or the cholera crapuloso of infants, may be 
 continued to a chronic form ; and when it has assumed this, it 
 presents like phenomena. 
 
 1336. Dr. Cheyne, (p. 16.) describes this disease as com- 
 
OF DIARRHG2A. 397 
 
 mencing with a purging and griping pain, in which the dejec- 
 tions are of a green colour." So do the diarrhoeas of infancy, 
 "very often, let the period of attack be when it may; for though 
 in the mild forms of this disease, especially in the very beginning, 
 the stools are for the most part yellow, yet they are not so ne- 
 cessarily — for we have a hundred times seen them green from 
 the very first discharge. 
 
 1337. " When this purging is neglected, and after continuing 
 for some time, there is added a retching, with or without vomit- 
 ing: when accompanied by vomiting, the matter brought up is 
 frequently coloured with bile," (p. 16, and 17.) Is this not pre- 
 cisely what happens in all looseness? Nothing is more common 
 in a diarrhoea of some standing, than this affection of the stomach, 
 or this appearance of the matter thrown up. 
 
 1338. " These increased and painful actions of the alimentary 
 canal, produce a loathing of every kind of food, and naturally 
 are attended with emaciation and softness of flesh, with restless- 
 ness, thirst, and fever," (p. 17.) Is this not the ordinary march 
 of neglected, or iil-treated diarrhoea? 
 
 1339. "After some weeks, I have often observed a hectic 
 blush on the cheek; but the most characteristic symptom of this 
 disease is a constant peevishness, the effect of unceasing griping 
 pain, expressed by the whine of the child, but, especially, by the 
 settled discontent of its features; and this expression of discon- 
 tent is strengthened towards the conclusion of the disease, when 
 the countenance has shared in the emaciation of the body,'' 
 (p. 17.) Who has not observed all that is said here, when di- 
 arrhoea had become protracted, and was hastening towards a 
 close 1 
 
 1340. "In the progress of the disease, the evacuations from 
 the belly show very different actions of the intestines, and great 
 changes in the biliary secretions ; for they are sometimes of a na- 
 tural colour, at other times slimy and ash-coloured, and some- 
 times lienteric," (p. 17.) Every author who has written on the 
 subject of diarrhoea, describes this mutable complexion of the 
 faeces in this complaint. 
 
 1341. "The disease seldom proves fatal, before the sixth or 
 seventh week: I have seen, though rarely, a child recovered, 
 after the disease had continued three or four months; and, again, 
 I have seen the disease cut short by death, in the second, third, 
 
398 of diarrhcea. 
 
 or fourth week, before it had reached its acme* ; the sudden ter- 
 mination having been occasioned by an incessant vomiting and 
 purging, or by convulsions, from the immense irritation of the 
 bowels," (p. 18.) Cannot every practitioner of any experience 
 declare, he has witnessed the same abrupt, and unexpected ter- 
 mination of our summer and autumnal diarrhoeas I 
 
 1342. "The disease is more frequent in children, who have 
 been weaned before the eighth or ninth month, and, in particu- 
 lar, in those, who, in consequence of some accident happening to 
 the nurse, have been weaned abruptly," (p. 18.) These obser- 
 vations comport with all experience in this complaint; especially 
 in this country. So well aware are mothers of this fact, that 
 they never wean their children at this period, but from absolute 
 necessity. 
 
 1343. "This is a disease of the autumnal months. I have 
 seldom seen it, comparatively speaking, commence before the 
 solstice, nor after the end of the year; and I suspect that it is 
 most general in sultry seasons." This agrees with the periods 
 of our diarrhoeas of children, entirely. This complaint is most 
 rife with us, fronxthe beginning of July to the beginning of Oc- 
 tober. It is, certainly, too, more frequent, in our damp, hot 
 summers. We believe that moisture contributes considerably 
 to the production of this complaint, since the functions of the 
 skin are less perfectly performed than in dry summers. Our 
 present summer, (1825,) is, perhaps, unparalleled in the recol- 
 lection of any body, at least, for the intensity, and the long con- 
 tinuance of its heat and the dryness of the atmosphere ; and is so 
 far, (August,) unparalleled for its healthfulness. The bowel 
 complaints of children are few, and of easy management, when 
 compared with other seasons. 
 
 1344. " At the time when weaning brash comes on, the teeth 
 are usually appearing; and from a common notion, that a flux is 
 wholesome during teething, the disease is sometimes allowed to 
 make irremediable impression on the constitution, before the 
 physician is called." In this, there is the most perfect coinci- 
 dence, with our " summer complaint," both as regards period 
 and consequences. 
 
 1345. The post mortem appearances, detailed by Dr. Cheyne, 
 correspond with those made in this country, as well as those by 
 Andral and Cruveilhier, in France. They are every way so in- 
 
OF DIARRHCEA. 39D 
 
 teresting and important, that we trust, we shall be excused for 
 quoting them, especially as they are short. 
 
 1346. " In every instance, I observed that the intestinal canal,, 
 from the stomach downward, abounded with singular contrac- 
 tions, and had, in its course, one or more intus-susceptions; that 
 the liver was exceedingly firm, larger than natural, and of a 
 bright red colour, and that the enlarged gall-bladder contained 
 a dark green bile. In some dissections, the mesenteric glands 
 were swelled and inflamed; in others, however, these were 
 scarcely enlarged, and had no appearance of inflammation." 
 
 1347. " These contractions and intus-susceptions, are entirely 
 of a spasmodic kind, as in the latter, the contained part of the 
 gut was easily disengaged from that which formed its sack ; and 
 in no part of the entanglement were there adhesions, or even 
 the marks of inflammation; and the contracted portions of the 
 intestines were again permanently dilated, by pushing the fin- 
 ger into them," (p. 22, and 23.*) 
 
 1348. " These appearances lead me to imagine, thatthe wean- 
 ing brash, in its confirmed state, is imputable to an increased 
 secretion of acrid bile, or rather to the morbid state of the liver, 
 which occasions this," (p. 23.) 
 
 1349. In the chronic form of this disease, we can readily ima- 
 gine the hepatic system to be deranged ; and the secretions of the 
 liver, by being either imperfect. in their kind, or acrid in their 
 quality, may over stimulate the already severely irritated intes- 
 
 * Intus-susception is,-perhaps, among the most frequent causes of death, vvherr 
 this disease lias run on so long-. It has Been observed by almost all writers, that 
 this form of diarrhoea terminates sometimes very suddenly, by violent vomiting", 
 or convulsions. Now, is it not more than probable, in these cases, that the im- 
 mediate cause of death may have been the invagination of the intestine? 
 
 This condition of the bowels would seem to exist much oftener then is sus- 
 pected; and to an extent that is almost incredible: thus, Mr. Burns informs us,, 
 that in one case, no fewer than forty-seven intus-susceptions were found in the 
 same body; and that invagination of the intestines is the most frequent cause of 
 fatal diarrhoea; that not less than fifty cases had occurred to his brother, in the 
 course of his dissections. (Vol. II. p. 199, James' Ed.) 
 
 This condition of the bowels unquestionably occurs, where no suspicion is en- 
 tertained of its existence; for we have no certain diagnostic of intus-susceptionu. 
 In general, it may, however, be remarked, where there is more than usual pain; 
 bloody slimy stools; violent vomiting, sometimes of faeces, and convulsions, this. 
 situation of the bowels may be suspected. 
 
400 OF DIARRHCEA. 
 
 tines, either to profuse secretion, inflammation, -inordinate action, 
 or spasm. The first, or profuse secretion, may account for the 
 quantity of the matter discharged; while the others may serve 
 to explain the various appearances of the dejections, their great 
 frequency, the stale of contractions, and the intus-susceptions of 
 the iniesiines. Thus, while the stomach and bowels preserve 
 their powers, or are but very little impaired, we see the feces 
 of a yellow colour and pretty abundant; or they may be even 
 green, without their being very seriously implicated; provided 
 the tone of green be not very intense, pretty uniform in con- 
 sistence, and somewhat gelatinous. 
 
 1350. When the bowels are more severely irritated, as almost 
 always happens, after the disease has continued for ten or twelve 
 days, and more or less inflammation present, there is strong evi- 
 dence of the liver participating in the affection, by the increased 
 quantity of bile ; this now becomes flocculent, as it were, of a 
 deeper colour, and not unlike green chopped rue, with copious 
 watery discharges. When the bowels are still more urged by 
 increased or more extensive lesion, the stools become of a brown 
 colour, much resembling chocolate, and are extremely fetid. 
 But, should the liver itself be much affected, the feces may be- 
 come of a yellowish white, or pus-like. 
 
 1351. In the commencement of this complaint, or during 
 what we have termed it>s acute or sub-acute form, we believe 
 that the stomach and the smaller intestines, are alone deranged; 
 and, hence, when this disease is taken early, and properly 
 treated, it is easily controlled. But, if the exciting cause be 
 continued, and the complaint injudiciously treated, the liver, 
 from its strong and constant sympathy with the stomach and 
 bowels, becomes involved ; and when this happens, the disease 
 becomes more severe in its symptoms, and more permanent in 
 its duration — it then constitutes diarrhoea in its chronic form. 
 
 1352. The bowels may now be urged to severer duties, by the 
 presence of a greater quantity of bile; and the very irritation 
 arising from this cause, serves both to augment and perpetuate 
 the secretion, by the liver sympathizing with the over-stimulated 
 bowels ; so that they reciprocally injure each other. Or, the same 
 effects may follow, and doubtless do sometimes, when the quan- 
 tity of bile is not augmented, but altered in its quality; or neither, 
 perhaps, need be required in someinstances, provided the mucous 
 
OF DIARRHCEA. 401 
 
 coat of the intestine, be inflamed — a circumstance known to oc- 
 cur, by post mortem examinations. 
 
 1353. It may be asked; how is it, if bile be not altered in -its. 
 quality, that it should produce inconvenience to parts over which, 
 in the best health, it constantly flows? There is a law of the 
 system which satisfactorily explains this — which is, that . secre- 
 tions do not injure parts over which they flow, as long as these 
 parts remain sound or healthy ; but if they are injured in any 
 way, then these secretions become causes of irritation, and even 
 of inflammation. Thus it happens with the bowels : in a healthy 
 condition, they receive from the bile a healthy stimulus; but if, 
 from any cause, they become irritated, as in the chronic form of 
 diarrhoea, their natural stimulus, the bile, may, from their altered 
 condition, become a source of serious mischief. 
 
 1354. When this complaint has run on for a long time, espe- 
 cially in children who have been weaned, and have suffered 
 directly from the change of diet, the mesenteric glands are some- 
 times found inflamed, and enlarged ; but this is by no means con- 
 stant. We have seen death from this complaint, where, upon. 
 examination, no injury was found to have been sustained by the 
 mesenteric glands. At other times, we have seen them an entire 
 mass of disease. 
 
 1355. Dr. Cheyne asks, " May not this (the enlargement of 
 the mesenteric glands) proceed from the acrid nature of the ali- 
 mentary matter, to which their absorbing mouths are exposed? 5 
 (p. 27.) W 7 e believe this to be the fact; and that their swelling, 
 or becoming inflamed, was an effort to arrest the farther pro- 
 gress of this acrid substance, as a bubo does the venereal poison. 
 
 1356. Dr. Cheyne, after having stated his opinion, as just no- 
 ticed, that a morbid condition of the live? and its secretions may 
 be the cause of " weaning brash," very modestly declares him- 
 self afraid of attempting an explanation of the phenomena. He, 
 however, proceeds to do it in the following manner: — 
 
 1357. " The breast milk^s a mild food, adapted to the powers 
 of the child ; I shall not say, the weak powers of digestion in 
 the child; but rather to the- peculiar powers, and properties of 
 the secretions. When the child is weaned abruptly, and put 
 upon common food, this becomes too violent a stimulus to the 
 intestines. Between the liver and intestines, there is the most in- 
 timate relation. This excited state of the intestines causes a dis- 
 
 51 
 
402 OF DIARRHCEA. 
 
 charge of bile into them, which increases the stimulus and assists * 
 in maintaining the purging. Had the original cause been acci- 
 dental and transitory, the bile, like the operation of a smart 
 purge, would have thrown off the offensive matter and cured the 
 complaint; but crude unfit food, being still poured into the 
 stomach, the disease must proceed. It is probable, therefore, 
 that, in the first instance, a redundant secretion of the bile, which 
 may also be an acrid and imperfect one, originating from an ir- 
 ritation of the stomach, is a salutary exertion of the system, to 
 remove the cause of the irritation from the intestinal canal. But 
 I think it, likewise, probable that the frequent repetition of this 
 effort, brings the liver into such a state, that it cannot return to 
 the performance of its ordinary and natural function, when the- 
 demand for its unusual action ceases; and it is in this manner 
 that the disease may continue, after the original stimuli have 
 been removed, by putting the child upon a proper diet." 
 
 1358. " The dejections are sometimes ochery, or even clay- 
 coloured, which does not seem to favour the idea of a redundant 
 secretion of bile. However, they continue pale but a short time,, 
 and soon resume the thin consistence, with their dark colour. 
 The explanation of this, I presume to be, that, during this inter-, 
 val, the spasmodic contraction may have seized the duodenum at 
 that part where the common duct emulges the bile into the in- 
 testines. And, farther, I presume the intestines have now become 
 so irritable, that they are stimulated to inordinate action by the 
 aliment, even at the time when, from the supposed stricture of 
 the duct, the bile may be deficient ; and, hence, the griping pain 
 still continues." 
 
 1359. " But it may be, and, most probably, is in the ducts, 
 that the explanation of this irregularity, in a great measure, is to 
 be looked for. I have, upon dissection, found the bi!e collected 
 in such quantity in the gall bladder, that this accumulation be- 
 came the cause of the confinement of the bile; for then the na- 
 tural curve which the cystic duct takes, becomes so acute, and 
 the distended bladder presses so much upon it, that the bile is 
 prevented from flowing, or flows in very small quantity. By this 
 retention, the bile becomes more concentrated, and thence, per- 
 haps, more acrid. And, finally, by some action of the stomach 
 and duodenum, by which the very enlarged gall-bladder is com- 
 pressed, part of its contents is forced out ; the distended diicts are 
 relieved, and the intestinal canal is inundated with bile," (p. 24,} 
 
OF DIARRHCEA. 403 
 
 13G0. Dr. Cheyne farther observes, "Notwithstanding my 
 most diligent inquiries, I have seldom been able to deduce any 
 of the derangements of* the infantile system from teething; and 
 I have been inclined to think, that those physicians who have 
 represented this function as teeming with danger, have not ac- 
 customed themselves to that careful investigation, without which 
 these diseases cannot be understood. The weaning brash, Ihave 
 the strongest reason to believe, has no connexion with teething, 
 farther than they sometimes meet in the same child. I have 
 known this disease, in many instances, where the gums were 
 neither swelled, indurated, nor inflamed, and where there was 
 *io salivation, nor the least appearance of pain in the mouth. I 
 have seen it where children were cutting their teeth easily; and 
 where many of them came without difficulty before weaning; 
 still -the disease has supervened. But, perhaps, the strongest ar- 
 gument that can be used, would arise from the observation which 
 I have frequently made, that this disease occurs in children of 
 three months ; and I have often known it several months before 
 teething came on." 
 
 1361. We have already expressed our belief, (p. 322,) that 
 teething in itself is no disease ; but that, in many instances, it 
 either calls interaction some latent disposition to disease, or ag- 
 gravates any that might be present during the continuance of 
 that process. If teething were a disease, strictly speaking, it 
 would be more uniform in its consequences, or present phenome- 
 na peculiar to itself; but this it does not always do ; for we have 
 many times known teeth to make their appearance, long before 
 the ordinary period, and when they were not announced by any 
 one of the usual phenomena. ' We have also known them make 
 their way so silently, and this about the period at which they 
 might be looked for, that the only knowledge of their approach 
 was their presence. All this we say in confirmation of Dr. 
 Cheyne's observation. 
 
 1362. But, on the other hand, we are equally certain, that the 
 process of teething disturbs the system under particular circum- 
 stances, and that, sometimes, very powerfully, by calling into ac- 
 tion certain dispositions, which cannot very well be subdued until 
 the disturbance in the gums, or the local, or teething irritation, if 
 you please, has been either moderated, or subdued. Therefore, 
 when this subject is looked at in a practical point of view, it must 
 be considered almost a dispute about words ; for whether the aQt 
 
4U4 OF DIARRHOEA. 
 
 of teething be a disease in itself, or whether it excite those which 
 are latent, or exalt those which may be- present, we must, re- 
 gard ihe circumstance of teething, as one well meriting the 
 attention of the practitioner : and, farther, ifhe disregard the prac- 
 tical hints this operation affords him, we fear he will often pro- 
 tract the sufferings of his little patient, or sometimes even 
 witness its death, 
 
 1 363. In the disease in question, we are certain that the most 
 decided and prompt benefit I as arisen from incising the gums'; 
 and when the teeth are really aggravating the complaint, it is in 
 vain we prescribe remedies, unless we remove this source of irri- 
 tation from the constitution, by aiding nature to push these bo- 
 dies through the irritated or inflamed gums. We do not mean 
 this literally ; for we have before observed, that two processes 
 were going on to effect what is called cutting teeth; namely, ab- 
 sorption, and the mechanical enlargement and pressure of the 
 tooth itself; for did not both contribute to this end, the state of the 
 gum would remain stationary, at least for a very long time. 
 We must, therefore, very often regard cutting the gums as one' 
 of the remedies proper in the '* weaning brash." 
 
 1364. For the prevention of the "weaning brash," Dr. Cheyne 
 advises, that, as this disease appears " much oftener in the au- 
 tumn than at any other time of the year, that -delicate children 
 should, at that season be kept a month or two longer at the 
 breast than might be thought necessary at any other, rather 
 than be exposed to the pains and hazards which never fail to 
 accompany this distemper," (p. 33.) 
 
 1365. This advice is in strict conformity to the usage of this 
 country: it is so well understood by every body here, that a phy* 
 sician is rarely consulted about its propriety. During the months 
 of June, July, August, frequently September, weaning is never 
 performed as a matter of choice, let the age of the child be ever 
 $o proper, unless k have completed the cutting of its first set of 
 Steeth. The dread o^ our females, in this country, is the " second 
 summer." 
 
 1366. No fact appears to be better ascertained, than that the 
 " second summer," is one of severe suffering, and oftentimes one 
 of great hazard to our infant population. Every mother seems 
 to be aware of the disposition of the bowels to become diseased 
 at this period of the child's life; but she limits the apprehension, 
 .-almost exclusively, to the consequence of "teething," We hav© 
 
OF DIARRHOEA. 405 
 
 already declared our belief in the agency of this act, when un- 
 toward, in the production, or aggravation of the complaints of 
 ihe bowels ; but this is only one of the sources of evil to the poor 
 weaned child at this period — the change of diet immediately af- 
 ter this -has taken place, as has already been observed, is an- 
 other. 
 
 13G7. In keeping the child, then, at the breast during the 
 .months of the second year, as above specified, is most decidedly, 
 but tacitly acknowledging the influence of the long-continued 
 operation of a hot sun upon the.tender system of children, ra- 
 ther than proving the direct agency of teething in producing their 
 bowel complaints; since they are, during the first summer, at 
 those periods of greatest heat, very liable to diarrhoea, though 
 this disease may be, and but too often is, aggravated in the second 
 year by the process of teething. 
 
 1368. Our long summer heats, generate " disposition" to dis- 
 ease, in both the hepatic and intestinal systems; and, of course, 
 require, at such periods, but slight exciting causes, to arouse them 
 into action ; and these causes, unfortunately, are so numerous, 
 .and of such certain application, as to give the child, in its "se- 
 cond summer," but a poor chance to escape 'with impunity. Our 
 children are tempted at this period of their lives, and at this hot 
 season of the year, by the offering of fruit in every stage of im- 
 maturity ; or of an over quantity of that which may be perfect. 
 They are liable to receive from the hands of but too many in- 
 considerate people, food of the most improper and indigestible 
 'kind; and, at the same time, they are menaced with ail the 
 M penalties" of difficult dentition: can it then be a matter of sur- 
 prise, that, at this period, they should be assailed by disease, or 
 that they should succumb under its influence 1 
 
 1369. It is confirmed, by multiplied observation, that at no 
 other periods of the year, is there the same risk in weaning, as 
 in the commencement, and at the termination of our summers; 
 and this from the causes we have just mentioned: they are, 
 therefore, eschewed with the utmost care, when there is a choice 
 upon the subject. Is this not a farther proof, that the effect of 
 season is more to be dreaded, than the mere process of dentition? 
 since, at other portions of the year weaning may take place with 
 impunity, if the organs of digestion be sufficiently confirmed by 
 age to bear a change of diet, though teeth may be pretty rapidly 
 pushing through the gums? Again; it is a fact perfectly well 
 
406 • OF DIARRHffiA. 
 
 known, that children are born in every day of the year, conse- 
 quently, they must cut their teeth at every period of the year: 
 yet, but one part of this time is considered dangerous for this 
 operation ; and "the supposed direct consequences of this act, 
 namely, diarrhoea, is familiarly called the "summer complaint of 
 children !° It, therefore, only amounts to what we have already 
 attempted to prove, that teething is but the exciting cause of 
 diarrhoea. 
 
 1370. To diminish the risk at this period of life, the remote 
 and the exciting causes of diarrhoea, or " weaning brash" must 
 be as far as possible avoided. 1st, Of the remote causes. The ut- 
 most attention should be paid to the clothing of the child, (see 
 Book I. p. 83, par. 226,) that it may not suffer from either an 
 excess or deficiency of it ; 2dly, it must be protected against the 
 chilling effects of a damp and cold atmosphere, by removing it 
 from it, when practicable, as in certain locations; prohibiting its 
 exposure to the dews of the evening, or to the fogs and dews of 
 the morning; to forbid or rather to prevent, the injudicious use 
 of the cold bath, &c; Sdly, to guard against the direct effects of 
 heat, by not exposing it to the hot sun, and to the too cool shade, 
 after such exposure. 
 
 1371. 2. Of the exciting causes. By being vigilant that the 
 child may not receive injury from improper food ; as crude fruit, 
 indigestible meats or vegetables; 2dly, that the child be not nursed 
 immediately after the mother or nurse has been overheated, or 
 recovering from a fit of anger, or any convulsive action of the 
 system ; nor to persevere in the use of the milk of the breast, 
 after evidence has been exhibited of its being of bad quality, 
 either from its age, its imperfect elaboration, or the return of the 
 catamenial discharge ; 3dly, to remove the irritation of teething, 
 when this manifestly arises from the condition of the gums, by 
 freely, and sometimes repeatedly lancing them ; 4thly, by pro- 
 tracting the period of weaning, until some time after the forbid- 
 den months, (638 ;) 5thly, by not weaning at too early a period of 
 the child's life, though the season of the year be proper ; # 6thly, by 
 gradually accustoming the child to a change of proper diet, pro- 
 vided it have a sufficient number of teeth for this purpose. (See 
 Book I. par. 695, et seq.) where we have sufficiently explained 
 our views upon this point. 
 
 1372. We firmly believe, that, were these directions strictly 
 complied with, it would rarely happen that .children would be 
 
OF DIARRHffiA. 407 
 
 afflicted with diarrhoea, in either its acute or chronic form. We 
 believe this, because we have more than once witnessed an en- 
 tire exemption from diseases of this kind, even in large families, 
 where strict attention has been paid to tr ise points. 
 
 Sect. Vll. — Of the Treatment of Chronic Diarrhoea, or " Weaning 
 
 Brash." 
 
 1373. Every body has experienced the difficulty of removing 
 a drarrhcea, after it has taken a chronic form. This arises from 
 several causes : 1st, because the hepatic s'ystem is now involved 
 with the intestinal, (1278 and 1349,) in maintaining this com- 
 plaint ; 2dly, because the stomach and bowels, independently of 
 the condition of the liver, are seriously affected, by either in- 
 flammation, (1340,) ulceration, contractions, or intus-susceptions; 
 3dly, because, very often, the irritation is maintained by the pre- 
 sence of worms, which are sometimes difficult to dislodge; 4thly, 
 because the influence of habit is added to the original disposi- 
 tion to too frequent dejections. 
 
 1374. When the first cause of difficulty alone prevails, the 
 disease, for the most part, is of pretty easy management; the 
 symptoms here may consist of too frequent discharges, of a green, 
 slimy, or curdled appearance ; with loss of appetite, nausea, and 
 sometimes vomiting, and of increasing emaciation, the skin, al- 
 most always dry, and very warm where covered ; the urine 
 scanty, and high-coloured; the thirst great; and the disposition 
 fretful, whimsical, or sluggish. 
 
 1375. Three indications here present themselves : 1st, to alter 
 the nature of the actions of the stomach, bowels and liver; 2dly, 
 to abate the frequency of the discharges; and, 3dly, to restore 
 the lost strength of the parts immediately concerned, and the 
 system in general. 
 
 1376. The first indication must be fulfilled by freely empty- 
 ing the bowels by castor oil, rhubarb or calomel, and then, by 
 giving'small doses of calomel; that is, from a quarter to half a 
 grain, morning and evening, with three grains of prepared chalk, 
 and from a tenth to a twentieth of a grain of opium, according 
 to the age of the patient. The second must be attempted, either 
 by rhubarb, or the cretaceous mixture: by rhubarb, during the 
 day, in the form of sirup, taken every three hours, in the dose 
 of a tea-spoonful, or half a tea-spoonful, with half a drop or a 
 
408 OF DIARRHC2A. 
 
 drop of laudanum, according to the age of the child, the degree 
 of pain, or as the motion of the bowels may be more or less fre- 
 quent * always proportioning the quantity of the laudanum, and 
 the frequency of its exhibition, to the exigences mentioned.. At 
 night, a sufficient quantity of laudanum by the mouth, or by 
 injection, should be given, to keep the bowels quiet until the 
 morning. 
 
 1377. By the cretaceous mixture, when there is evidence of 
 a prevailing acid-in the evacuations. This may be known, 1st,, 
 by the green being light, and the evacuations watery ; 2dly, by 
 the smell; 3d!y, by the appearance of portions of hard curd, 
 among the faeces: 4thly, by the discharges becoming greener by 
 standing ; 5thly, by the matter vomited, should vomiting attend,, 
 smelling sour, and the milk coming up in strong curd ; 6thly, by. 
 a dense white coat upon the tongue, which is. a stratum of milk 
 coagulum. 
 
 1378. The best form of giving the mixture, is as follows:— 
 R. Creta. ppt. 3iij. 
 
 Tinct. Thebaic. gut. xx. vel xxx. 
 
 01. Cinnam, g u *.j. 
 
 Sacch. Alb, Jij. 
 
 Aq. font. gijj. M. f. Julap. 
 
 A tea-spoonful of this must be given every two, three or four 
 hours, as it may influence the motions of the bowels. Where 
 the motions of the bowels are kept up by acidity, the effect of 
 this remedy is sometimes soprompt, that two or three doses will 
 entirely suspend the discharges — therefore, wherever this effect 
 is observed, the medicine should be suspended, until the recur- 
 rence of a fresh necessity. 
 
 1379. If it do not show this decided control over the motions 
 of the bowels, it will, nevertheless, if the greenness of the evacu- 
 ations depend upon an acid, very much abate their frequency, 
 and change their green appearance to yellow; but should it de- 
 pend upon bile, it will have little or no effect. It may be per- 
 severed in, as necessity may require. But we always feel it 
 important, in such cases, to tranquillize the bowels, during the 
 night, by a suitable dose of laudanum. 
 
 1380. Should, however, the motions of the bowels be too long 
 arrested, that is, beyond eight or ten hours, an injection of mo- 
 lasses and water, or flax-seed tea should be given ; and, if necessa- 
 ry, it may be rendered more stimulating, by the addition of a little 
 
OF DIARRHCEA. 409 
 
 salt. In this way, the motions may be kept in subjection, or 
 rendered obedient to the wishes of the physician. During the 
 whole of the time, the most particular care must be paid to the 
 diet and drinks of the patient. 
 
 1381. Nothing heating or stimulating, should be given, either 
 as nourishment or as drink ; and every species of liquor, animal 
 food or broth, must be prohibited, if there be the slightest evi- 
 dence of fever. The diet must consist only of such articles as 
 the stomach can best manage, as milk and water, gum Arabic 
 and water, very thin arrow-root, sago, or tapioca, rennet whey, 
 barley water, or rice water. Nothing solid of any kind, should 
 be given. The occasional use of melted butter, is found often- 
 times highly advantageous, in every state almost of chronic diar- 
 rhoea ; but is especially so, where there is a predominance of acid, 
 and where there are sparing stools, accompanied by hard curd, 
 and a whitish mucus from the bowels tinged with blood. It is 
 made by pouring boiling water upon a lump of perfectly sweet 
 butter in a tea-cup, and stirring it until it is melted ; a tea-spoon- 
 ful is skimmed from the top, and given several times a day. 
 
 1382. It may be well' to observe, that during the period in 
 which too much acid prevails, but a very small quantity of milk 
 should be used, unless it be reduced by lime-water. — in this state 
 of combination, it may be given; or, if there be but very little 
 fever, or none, chicken or beef tea may be used, instead of the 
 vegetable jellies above mentioned ; with the exception, perhaps, 
 of the gum Arabic water. We are in the habit of continuing 
 this mucilage throughout the complaint, where it does not dis- 
 agree, or where the child does not refuse it. 
 
 1383. The third indication maybe fulfilled, by the proper use 
 of diet — permitting the use of weak broths, without vegetables 
 being boiled in them, with the exception of rice; but even this 
 must be strained from them before they are given. A soft-boiled 
 fresh egg, may after awhile be given; a portion of ham may be 
 sucked ; or a little well-boiled rice, with sugar, very fresh butter, 
 and a little nutmeg, may be made to follow from time to time. 
 
 13S4. But if the child be weaned, nothing will so certainly 
 contribute to its recovery, as its restoration to the breast, when 
 practicable ; or, if the child be at the breast, and there is room 
 to suspect the quality of the milk, a fresh nurse should be imme- 
 diately procured. Should the teeth be in fault, the gums should 
 
 52 
 
hen 
 
 410 OF DIARRH02A. 
 
 be freely cut. Suitable exercise must be instituted ; and, w 
 practicable, the child should be sent to the country for the bene- 
 fit of a change of air. 
 
 1385. Where the second condition (1373) obtains, the disease 
 must be considered not only very far advanced, but highly dan- 
 gerous; for it must not be concealed, that more or less danger 
 must attend an inflammation of the mucous membrane of the in- 
 testines. Have we any certain marks, to distinguish this condi- 
 tion of the bowels? It may be suspected, where the pulse is very 
 much accelerated ; where the child is extremely restless ; drawing 
 up its feet and thighs towards the abdomen ; crying loudly, or 
 moaning frequently; if pain be increased by pressure upon the 
 abdomen; if the skin be hot, and parched ; if the evacuations be 
 extremely frequent ; a disposition to tenesmus ; if the evacuations 
 be sparing, slimy, or bloody, though frequent; if the thirst be 
 excessive ; and the tongue dry, red, and tender. All these symp- 
 toms, or the greater part of them, may attend an inflammation 
 of the mucous tissue of the intestines. 
 
 1386. The indications here, are, 1st, to abate the local inflam- 
 mation; 2dly, to change the nature of the secretions of the liver 
 and bowels, and to allay the irritation of the intestines; 3dly, to 
 diminish the frequency of the discharges; and, 4thly* to restore 
 lost strength. 
 
 1387. The first indication must be attempted to be fulfilled, 
 by local depletion, by leeches ; by the occasional use of the warm 
 bath ; by blisters on the abdomen or thighs. The second, by the 
 exhibition of the calomel in alterative doses: and by small, but 
 repeated doses of castor oil. The third, by the occasional use 
 of laudanum enemata, when they can be retained; or by its ex- 
 hibition in small but repeated doses, by" the mouth. And the 
 fourth by proper diet, as above proposed; by exercise; and by 
 removal to the country. 
 
 1388. In this, and in the subsequent stage, it may be proper 
 to observe, that nothing but rennet whey,' or weak gum Arabic 
 water should be given as nourishment, and even these in but 
 very small quantities.* The thirst is best slaked by a tea-spoon- 
 ful of cold water, given from time to time. 
 
 • We are persuaded, that one of the most operative causes against the recovery, 
 in every bowel complaint, is the too frequent exhibition of food, both proper and 
 improper; especially during its active stage. The fear of weakness leads inces- 
 
OF DIARRH02A. 41 1 
 
 13S9. When this disease is still more advanced, and has been 
 of long continuance, we have a right to suspect, what has been 
 but too often proved by dissection to happen under such circum- 
 stances, contractions, ulcerations, and intus-susceptions. We 
 have no diagnostic symptoms for these conditions of the bowels; 
 and, if we had, it might be justly doubted whether the know- 
 ledge of them would lead to any valuable practical end. We 
 fear that, in these cases, no other plan can be pursued, but a 
 temporizing one; for it is to be presumed, that every effort has 
 been made during the previous stages of the disease, to arrest its 
 progress. Therefore, we need but rarely flatter ourselves with 
 the hope of a recovery, where the emaciation and weakness are 
 extreme ; where nothing, or next to nothing, can be retained 
 upon the stomach; where the abdomen becomes tympanitic; 
 where there is almost a total stoppage of the secretion of urine ; 
 and where the stools are extremely offensive, dark brown, large 
 in quantity, and mixed with either blood or a puriform matter, 
 or both ; and, above all, when these are very frequently, and in- 
 voluntarily discharged. 
 
 1390. We have frequently known the bowels to continue to 
 be purged, and that for a long time, by the presence of worms 
 in the alimentary canal. We always suspect this cause, when 
 the complaint has resisted the usual remedies; where the teeth 
 cannot be in fault; where there is no appearance of bile, and 
 especially, when the stools are of a dark brown colour, very 
 thin and very offensive. The child, also, may have a tumid 
 belly ; a strong, or offensive breath ; a furred tongue ; a voracious 
 or diminished appetite ; itching of the nose, and sometimes regu- 
 lar febrile paroxysms. 
 
 1391. We, in such cases, treat the disease as a worm case; 
 either by pink-root, worm-seed oil, or calomel. We always give 
 a decided preference to the first remedy, where it is practicable 
 to get the child to take it. And we may almost always succeed 
 in doing this, with children who are of sufficient age to sit at ta- 
 
 santly into error, on this subject; and neither reason nor experience is capable of 
 destroying this absurd and dangerous practice. Every body would at once ac- 
 knowledge it to be, not only preposterous, but even cruel, to place an additional 
 weight upon the shoulders of a man who was staggering under the load already 
 laid upon them; but they would think it right to do what is equally absurd and 
 cruel to the stomach, by forcing upon it a fresh quantity of food, when it had not 
 power to dispose of that which it had previously received. 
 
412 OP DIARRHCEA. 
 
 ble, and who are in the habit of drinking coffee, by using the 
 pink-root in the following manner: — 
 
 1392. Take the proper quantity of pink-root,* and pour upon 
 it about half a pint of pretty strong boiling coffee, and permit it 
 to draw — pour off one-half into a cup, sweeten it, and put milk 
 or cream in it, and give it to the child, as if it were pure coffee, 
 (for it is not to be informed it is not:) it will drink this almost 
 always without the slightest hesitation. It will receive the other 
 half at tea-time, managed as before. This must be repeated for 
 three days, consecutively : on the fourth, should the bowels not 
 be opened, (for it almost always stops the discharge in this pe- 
 riod,) let the child have a dose of castor oil, or a few grains of 
 calomel. 
 
 1393. It must be observed, we have seen a stop put to a diar- 
 rhoea of very long standing, by a few doses of the pink-root, and 
 this, sometimes, without any ocular proof that worms were the 
 cause of it — we have, therefore, for many years past, made it a 
 rule, to exhibit this remedy, when the complaint has resisted the 
 ordinary means. 
 
 1394. If the pink-root cannot be given, the worm-seed oil may 
 be substituted,! but it is by no means so certain. If neither can 
 be given, or if there be too much fever for the worm-seed oil, 
 (for it should never be given at that time ;) the calomel may be 
 used, and sometimes with the most prompt and decided advan- 
 tage. 
 
 1395. The following case, which has lately been under our 
 care, will illustrate this practice very well. A child of C. E. C. 
 was weaned at four months, in consequence of the illness of the 
 mother. It was, however, very well nourished by the bottle; 
 it throve well, and had several teeth before it was seven months 
 old. It was attacked in the month of June with the bowel com- 
 plaint of the ordinary kind, from which it was pretty speedily 
 relieved by calomel, &c. In July it had a return of this com- 
 plaint, with more violence than formerly ; owing, it was sup- 
 posed, to several teeth that were making their appearance. 
 
 * The dose of this article may be from a quarter of an ounce to half an ounce. 
 The first quantity will do for children, from ten months to a year; one-third of an 
 ounce, from this time to two years; half an ounce from this period to seven years 
 old. 
 
 f There are printed directions for its use, accompanying" each bottle of the oil. 
 
OF DIARRHCEA. 413 
 
 1396. The gums were considerably swelled, and inflamed; 
 and the child slavered very freely. Its lax was very profuse, but 
 the stools were of a good colour. The te"eth were liberated by 
 lancing the gums; the diarrhoea abated by the use of calomel, 
 sirup of rhubarb, and a testaceous mixture, and the child sent to 
 the country to recruit. About a fortnight after it had been there* 
 the bowel complaint returned with considerable severity; its eva- 
 cuations were very frequent, bilious and offensive. The former 
 remedies were again tried, but not with the former success. The 
 child began to emaciate; to become sick at the stomach, voiding 
 green, acrid and watery stools. By the use of absorbents, and 
 very small doses of calomel, he was again relieved ; but this was 
 but for a short time. 
 
 1397. The bowel complaint became now very severe; the belly 
 was much enlarged; the urine nearly suppressed ; the child very 
 languid and fretful; its food would frequently pass through it 
 without change ; it would almost every day have a kind of spasm 
 in all the muscles of the body, which would last sometimes for 
 many minutes together, and -these would be repeated three or 
 four times a day. A regular paroxysm of fever established itself 
 at six o'clock, every evening, which would terminate next morn- 
 ing in a profuse perspiration; the child was incessantly picking 
 its nose, was very fretful, and whimsical; appetite sometimes 
 good, at other times would refuse every thing. When the febrile 
 paroxysm was off, the pulse* was pretty natural; its tongue was 
 much loaded, and its mouth studded with many little painful 
 pimples, and ukerations, a great quantity of very tenacious, trans- 
 parent saliva flowed constantly, even to annoyance. The child 
 was now turned of ten months, and had ten teeth; the gums were 
 carefully examined, but there was no swelling of them, to lead 
 to the suspicion that dentition was the cause of the symptoms. 
 
 1398. Believing there were worms in the case, knowing the 
 impossibility of giving the pink-root, and that the system was 
 not in a situation to receive the worm-seed oil, we determined on 
 the use of small but frequently repeated doses of calomel, as in 
 the following formula: — 
 
 R. Calom. ppt. gr. iij. 
 
 Creta. ppt. 9j. 
 
 Gum. opii. gr. ss. 
 
 M. div. in xij. parts. 
 
414 OF DIARRHCEA. 
 
 1399. One of these was ordered to be given every two hours, 
 until bed lime, at which time six drops of laudanum were to be 
 taken. On our visit the next morning, we learnt the child had 
 passed two worms, and was evidently much relieved.* The 
 bowels were much less frequently moved. The powders were 
 ordered to be continued. The medicine operated pretty freely 
 the next day — brought away nothing very remarkable, except 
 dark green slimy bile. The powders were continued, and was 
 informed the day after, (being indisposed, did not see the child,) 
 that the child had passed, the previous night, a knot of worms of 
 the size of a nutmeg. This was all the information we received 
 but that the child was very well. 
 
 1400. Habit sometimes perpetuates the discharges from the 
 bowels : this cause may be suspected when the evacuations occur 
 at nearly stated periods of the day; when they are not continued 
 through the night, and when the digestion goes on well, and the 
 stools look natural. Children, from the long continuance of di- 
 arrhoea, and those of sufficient age to feel a sense of shame, and 
 especially those who have been schooled into good habits in re- 
 gard to their evacuations, are always sure to obey the first im- 
 pulse, or warning, the bowels give, that a discharge is about to 
 take place, and by this means, no doubt, have provoked an eva- 
 cuation, w T hich a little self-command might have checked. By 
 this means almost all influence over the sphincter is lost, and the 
 discharge is maintained from habit. 
 
 1401. Laudanum we have found the best remedy for this kind 
 of diarrhoea, especially when combined with prepared chalk; it 
 should be given as frequently as the state of .the bowels would 
 seem to require — that is, given immediately after each evacua- 
 
 * The character of these worms, as far as we could judge of them in their mu- 
 tilated state, was altogether different from any we have seen; and entirely diffe- 
 rent from each other. We regret that sufficient care had not been taken of them, 
 to prevent injury. One was about double the length of the other; it was of a 
 dark brown colour, broader at the tail extremity than at the head. It was seen, 
 by the aid of a strong glass, that the head was of a triangular form, and evidently 
 had two osculi. The body was so much injured by compression, that we can say 
 nothing certain about it. The other was about four inches in length; of equal 
 thickness throughout; of a pale yellowish red, transverse lines very near each 
 other through the extent of the body; the position of the mouth appeared to be 
 transverse, and the head obtuse and round. 
 
OF CHOLERA INFANTUM. 415 
 
 tion, and telling such as can comprehend the instruction, not to 
 obey the desire as long as they can possibly resist it. 
 
 CHAPTER XXVIII. 
 
 OF CHOLERA INFANTUM. 
 
 1402. This is a disease almost peculiar to the climate of the 
 United States; and, indeed, we might say it is limited very much 
 to the middle and southern states. Children, in otheT countries, 
 are liable, during dentition, or from other causes, to various af- 
 fections of the alimentary canal, all of which differ from our en- 
 demic. 
 
 1403. The exciting causes are, improprieties in diet and 
 clothing; and it is, likewise, very often aggravated by teething, 
 worms, by premature weaning, and by a variety of adventitious- 
 circumstances, fc- *Jfc 
 
 1404. Cholera infantum makes its approaches in different 
 ways. In some instances, it comes on as a simple diarrhoea, 
 though the stomach is also very apt to be affected; and in its 
 more violent forms, there are vomitings and purgings, attended 
 by no considerable spasmodic uneasiness, constituting the cho- 
 lera morbus of farther advanced life. In its ordinary forms, 
 the fever, which soon supervenes, is of an irregular remittent 
 character ; the exacerbations being highest in the evening. The 
 pulse is usually small, quick, and feeble, or irritated and corded ; 
 but rarely full, strong, or voluminous. Determinations to the 
 brain, or, at least, this organ seems early to be affected sympa- 
 thetically; as is manifested by a tendency to stupor or delirium, 
 or sometimes even frenzy. The eyes, also, denote this cerebral 
 affection: they are either fierce, or languid in expression; and 
 when the patient sleeps, are half closed. Thirst is intense, and 
 for a time really unquenchable— cold water is clamorously de- 
 manded, but if swallowed, is instantly rejected.* An unequal 
 distribution of temperature commonly exists; the head and re- 
 
 • We are, however, disposed to believe this would not so generally happen 
 were this article more judiciously administered, than it usually is. From the ve- 
 hemence with which drink is seized by the little sufferer, it is evident how severe 
 
416 OF CHOLERA INFANTUM. 
 
 gion of the stomach and bowels being hot, while the extremities 
 are cold. 
 
 1405. The appearances of the evacuations from the bowels, 
 are various. The natural faeces are mostly retained, though oc- 
 casionally small lumps may be found involved in the other dis- 
 charges. These are sometimes thin and watery; and at other 
 times thicker and more tenacious; consisting chiefly of slime, or 
 mucus occasionally tinged with blood. The colour may be 
 green, or yellow, or white, or brown; and may be inodorous, or 
 exceedingly offensive. Commonly, however, the smell is that 
 of sourness, or of putridity. The irritability of the alimentary 
 canal is sometimes so great, that the ingesta rapidly pass off un- 
 altered, as in lientery. 
 
 1408. We have few diseases in which emaciation so rapidly 
 takes place, or where, in its later stages, there is a greater al- 
 teration of general condition and aspect. The child, at first, be- 
 comes pallid, and the flesh flabby; and, so completely is the fat 
 ultimately absorbed, that the integuments hang in folds; and in 
 those parts on which the body rests, livid spots appear, followed 
 by ulcerations. 
 
 1407. The skin on the forehead is tight, as if bound to the 
 bone ; the eyes are sunk ; the cheeks fall in ; the nose is sharp ; 
 and the lips are shrivelled. Even under such circumstances as 
 
 the thirst must be: to relieve this, water is given to it in full draughts, and is some- 
 times violently rejected, before the last portion has arrived at the stomach. 
 
 The child instantly renews its supplications for drink; and this with a counte- 
 nance so beseeching", and a manner so earnest, that no resolution, scarcely, can 
 resist the appeal, though there may be the most perfect conviction of its mischie- 
 vous tendency. Again it is presented, again it is swallowed, and again it is thrown 
 up — and so it would proceed, were the demands-constantly supplied, to an inde- 
 finite period. 
 
 Much resolution is required, for much firmness must be exercised, not to com- 
 ply with these insatiable demands? or, at least, to the extent that would satisfy 
 the craving and anxious child. But its vehemence may be amused, if not abso- 
 lutely diminished, by exhibiting the water by tea-spoonsful, and this as warm as it 
 can well swallow it; for such is its desire for something fluid, that it will swallow 
 the hot water as readily as the cold; or, if it like it less, it will sometimes be less 
 importunate in its demands. 
 
 We have several times seen the most prompt advantage result from exhibiting 
 to the little sufferer very small pieces of ice, every few minutes. It seems more 
 certainly to abate thirst, and at the same time tranquillizes the stomach better than 
 water: on this account it always deserves a trial with children of sufficient age not 
 to be injured by its being received in its mouth, at the risk of getting into the 
 windpipe. 
 
OF CHOLERA INFANTUM. 417 
 
 would seem to denote immediate dissolution, life will, in some 
 cases, be preserved for weeks, and a recovery iinally* take >place 
 The belly becomes tumid, from flatulence; the feet still more 
 frequently are oedematous; aphthae appear; the mind, as well as 
 the senses, which hitherto may not have been impaired, are now 
 obtuse, or so entirely lost, that the child lies unmoved by ordi- 
 nary excitements, and will even allow flies to collect on the face, 
 without being irritated or disturbed. This form of the disease 
 will sometimes continue for five or six weeks. But as death ap- 
 proaches, a gradual aggravation of symptoms takes place; and 
 there is Qne, which, as far as we have observed, has always 
 proved fatal;* it is a crystalline eruption upon the chest, of an 
 immensity of watery vesicles, of a very minute size. The best 
 idea we can convey of the appearance of this eruption, is to ima- 
 gine a vast collection of vesicles, apparently produced by flirting 
 an equal number of very minute drops or particles of boiling wa- 
 ter, and each particle producing its vesicle. We first pointed 
 out this appearance to our friend, Dr. Physick, in the year 1794, 
 in the disease now under consideration; and, subsequently, under 
 like circumstances, to Dr. Rush; both of whom acknowledged 
 the eruption was new to them. 
 
 1408. This symptom may readily escape observation, if not 
 looked for: it requires that the surface on which it has spread it- 
 self, should be placed between the eye and the light, and viewed 
 nearly horizontally. 
 
 1409. There is another symptom which attends the last stage 
 of this complaint, which is much more common, but not less fatal.; 
 which is the thrusting of the fingers, nay, almost the hand, into 
 the back part of the mouth, as if desirous of removing something 
 from the throat. The popular opinion is, that there is a worm 
 irritating the back part of the fauces. And we may mention 
 another, which we do not remember to have seen noticed, which 
 is, the escape of a live worm or worms in the chronic stage of this 
 affection. If the worm come away dead, there is nothing in the 
 .circumstance; but if alive, it is a fatal sign. We have remarked 
 the same in dysentery. 
 
 * A few months since, we saw this eruption on the chest in a lad of eighteen, 
 to whom our friend, Dr. Hays, called us in consultation. In this case, recovery 
 took place, after a very long and very severe struggle; the original complaint was 
 fever, with hemorrhage from the bowels. 
 
 53 
 
418 OF CHOLERA INFANTUM. 
 
 / 
 
 1410. In other cases, however, especially where this epidemic 
 puts on the character of cholera morbus, or dysentery, its pro- 
 gress is more rapid, and runs, in all respects, the course of these 
 affections. Death, in the former of these instances, will some- 
 times take place in a few hours; and, the latter, from three to 
 ten, or fifteen days. 
 
 141 1. The symptoms of this disease are so peculiar, and so well 
 defined in the genuine forms, that it will always be recognised 
 without difficulty; therefore, we need not dwell upon its diag- 
 nostics. And, where it imitates other affections, as cholera mor- 
 bus, or dysentery, or diarrhoea, it may be considered as essen- 
 tially such, requiring no difference of treatment. Cases most re- 
 sembling it, are some of those brought on by the irritation of 
 teething. Even here, however, the treatment is analagous, so 
 that no nicety of discrimination is required; though there are 
 circumstances in the season of the year; the wide spreading of 
 .cholera infantum, independently of symptoms, which will ena- 
 ble us to do it. 
 
 1412. The prognosis is far more difficult; since death some- 
 times happens most unexpectedly'; and recoveries- take place in a 
 state of things apparently desperate. In the most violent form of 
 cholera morbus, it often proves suddenly fatal. But cholera in- 
 fantum, in its ordinary forms, may be considered as doing welL, 
 where the pulse becomes slower, fuller and more natural ; where 
 temperature is restored to the surface, and equally diffused; 
 where the irritability of the stomach and bowels subsides; and, 
 above all, where the alvine discharges, previously denoting the 
 want of bile, now consist of dark bilious, offensive or inodorous 
 matter, or exhibit a more healthy aspect. Till this happen, or, 
 in other words, unless the liver is restored to its natural functions, 
 it may be laid down as an invariable rule, that convalescence does 
 not take place. 
 
 1413. An opposite prognostication may be made, or, at least, 
 imminent danger is to be apprehended where there is an absence 
 ^of the favourable signs just enumerated ; and, particularly, where, 
 with a cold damp surface, there is a small thready pulse; lank, 
 haggard countenance; incessant puking of whatever is received; 
 purging of a pink-coloured fluid, or of greasy fetid water, or of 
 a dark flocculent matter, attended with extreme nervous sensibi- 
 lity, or an entire extinction of it ; the child lying stupid, with its 
 eyes half closed and deeply sunk, or with occasional convulsions 
 
OF CHOLERA INFANTUM. 419 
 
 1414. In protracted cases, the eye-balls become perfectly 
 blood-shotten ; mimicking a genuine inflammation: but it is no- 
 thing but a case of pure error loci ; and must always be regarded 
 as a bad, but not necessarily a fatal symptom — we have seen 
 some few instances of recovery, after it had taken place. One 
 who is not experienced in this disease, may encourage hopes 
 which can never be realized. At. this period of the complaint, 
 or rather just before its fatal termination, the eye sometimes has 
 its brilliancy and vivacity renewed, after it had been a long time 
 nearly extinct; the general symptoms seem to abate; the child 
 receives food, even greedily : -and manifests an intelligence that 
 truly astonishes. But the practised eye sees nothing in these 
 changes, but the immediate forerunners of death. 
 
 1415. Dissections clearly inform us of the seat and nature of 
 cholera infantum. The brain presents no morbid appearances, 
 in recent cases, except those of congestion; but in the protracted 
 forms, effusions are often met with, constituting hydrocephalus. 
 
 1418. The viscera of the thorax are rarely affected. It is on. 
 the contents of the abdomen that it mainly expends its force. 
 The effects of previous inflammation may be traced in some 
 cases, throughout the whole of the alimentary canal; though it is 
 in the mucous membrane that they are principally to be found. 
 Dark livid spots, are dispersed over this coat of the stomach, and 
 of the small intestines, particularly the duodenum, near to the 
 pylorus. Coagulable lymph is also, in some instances, spread on 
 their surfice, or is found in detached pieces. In many parts, 
 there is an alteration of structure, by the thickening of their 
 coats; so much so, that the caliber of the tube is considerably 
 reduced. 
 
 1417. The large intestines are seldom involved in this. mis- 
 chief; and, perhaps, never, excepting where the disease assumes 
 the dysenteric form. Now and then appearances similar to those 
 of the prima? via?, may be seen upon the peritoneum, though not 
 to any extent. The liver, under almost all circumstances, and 
 especially in cases of long continuance, is greatly enlarged, so as 
 sometimes to occupy two-fifths of the cavity of the abdomen. But, 
 though thus increased, there is not any very evident derangement 
 of structure. Jt is merely distended, or swollen, by congestion, 
 and on this account, is more firm and solid, than natural — a state 
 of things, evidently induced by torpor in the portal circulation. 
 The gall-bladder, in ;omc instances, is found rilled with dark 
 
420 OF CHOLERA INFANTUM. 
 
 green bile, and at other times, with that which is pale, or nearfy 
 colourless.* The other viscera of the abdomen are usually healthy. 
 It may, however, be proper to add, that the contents of the bow- 
 els, for the most part, consist of a thick, tenacious mucus, involving, 
 small lumps of faecal matter, occasionally coloured by bile. When 
 this disease causes death, by assuming a chronic form, it very 
 much resembles the chronic form of diarrhoea, or weanino- brash*. 
 
 Treatment. 
 
 1418. The disease, as already stated, usually commences with, 
 a very disordered state of the alimentary canal; and it seems to- 
 be admitted, that our earliest endeavours are to be directed to the 
 evacuation of the stomach and bowels. As regards, however, 
 the precise course to be pursued, to effect this purpose, there is. 
 not the same unanimity of opinion. Generally, purgatives are 
 employed in preference to emetics; and especially the castor oiL 
 Cases of a mild nature may, undoubtedly, be treated in this way, 
 and, particularly, if laudanum be occasionally added, when there. 
 is little or no fever. But, in the more violent forms of the dis- 
 ease, attended by vomiting, it will be impossible to get such me- 
 dicines to be retained. It is, therefore, necessary that we at- 
 tempt to allay the iritability of the stomach. 
 
 1419. For this purpose, there is nothing so certain,or so prompt, 
 as an injection of a gill of warm water, in which is dissolved a 
 large tea-spoonful of common salt : this is for a child of a year old 
 and upward, proportionably less for younger. And, however fre- 
 quent the discharges may be per anum, it must not be regarded : 
 the injection must be given. If it operate immediately, and 
 bring with it a faecal or bilious discharge, the stomach becomes 
 almost immediately quieted, and may then be repeated only pro 
 re nala — that is, whenever the vomiting may be severe. Should 
 it not bring any thing off, it must be repeated; and an attempt 
 made to force it high into the bowels ; or should the vomiting not 
 oease, we must again have recourse to it.. 
 
 1420. This repetition of the injection will either procure the 
 discharge required, or it will produce a most salutary irritation of 
 the rectum, on which its chief efficacy depends. We would wish 
 this fact to be remembered; for a common injection of molasses, 
 
 * We have, in two or three instances, seen the/gall-bladder filled with a fluid 
 nearly as white as serum, and of but little more consistency. 
 
OF CHOLERA INFANTUM. 421 
 
 oil, and water, will do little or no good, though it may procure 
 a stool, as it lacks the stimulating ingredient, the salt, on which 
 its virtue depends. So decided and effective is this simple plan, 
 that we have a hundred times seen it relieve entirely, almost 
 without the aid of any other remedy. 
 
 1421. The great desideratum in cholera infantum, is to tran- 
 quillize the stomach : if the disease have been provoked by any 
 irritating matter in the stomach itself, it should be our first en- 
 deavour to remove it, by encouraging the puking, by draughts 
 of warm, or even cold water, where the warm will not be drunk, 
 until no foreign substance appears in the matter thrown up — but 
 do not let us administer an emetic; for, so long as nature conti- 
 nues her efforts to dislodge the offensive substance, it cannot be 
 required, as she will certainly succeed, if she be aided by warm 
 water; and it can never be otherwise than injurious, after it has 
 cast off the irritating material. 
 
 1422. When this complaint attacks very young children, 
 nearlv the same plan should be pursued — that is, an injection of 
 the same materials must be given, of nearly the same strength, 
 hut of less bulk, and this repeated, when necessary — of,. should 
 the first not succeed in allaying the irritation of the stomach, it 
 should be repeated in half an hour. A tea-spoonful of strong 
 coffee, without sugar or milk, every fifteen minutes, should be 
 given, especially to very young children ; but we believe all ages 
 would profit by it in larger doses. We have in a number of in- 
 stances, since we first tried it, seen it act like a charm. 
 
 1423. In the commencement of this disease, we have never 
 seen the temporizing remedies, as the alkalies, the absorbents, or 
 external irritants, of the smallest service : we, therefore, never 
 employ them. At this time, also, we discard all strong smelling 
 substances from the room ; and especially from the stomach with- 
 in, or the belly without; as mint, spices, brandy, gin, &c. ; as 
 we are convinced they arc extremely offensive to the stomach, 
 through the medium of the olfactory nerves. 
 
 1424. If the stomach have not been tranquillized by the injec- 
 tion, or the strong coffee, we immediately commence with minute 
 doses of calomel. We first prescribed the remedy in doses of 
 half, a quarter, or an eighth of a grain in cholera, in the year 
 1795; and we were, by some of our medical friends, severelv ri- 
 diculed, for the suppos^l insufficiency of the dose. But this did 
 not deter us from the practice ; for we have pursued it from thai 
 
422 OF CHOLERA INFANTUM. 
 
 period until the present moment, though we could then gain but 
 few to be of our opinion: since, however, Mr. Ay re has written 
 on the subject, it has got into general use. We never combine 
 opium with the calomel, in the early stage of the disease, being 
 convinced it is better to exhibit it alone. The following is the 
 form and average dose we use:— 
 
 - Vc. Calom. ppt. gr. iij. 
 
 Saccb. Alb. gr.vj. 
 
 M. div, in par. xij. 
 
 1425. One of these powders is thrown dry into the child's 
 mouth, every hour, until the bowels are decidedly operated or* 
 by them: this may be known, by the stools being more copious, 
 less frequent, and of a dark green colour, with a tenacious slime 
 of the same or nearly the same, tone of colour. When this change 
 is observed, the powders are given much less frequently; say, 
 once in two, three, or four hours, as the symptoms may have 
 abated, or proved refractory. After the bowels have been well 
 evacuated, and the child in pain, or pretty much exhausted, we 
 order an injection in the evening, with laudanum, proportioned 
 to the age of the child; provided there is not too much fever. 
 
 1426. Should the symptoms persevere, we renew the treat- 
 ment of the previous day, until similar effects be produced ; and 
 the laudanum injection at night: pretty much after this plan do 
 we treat the first or acute form of the disease. If much fever 
 attend, with great gastric distress, we have found the most de- 
 cided advantage from bleeding, or the application of leeches over 
 the region of the stomach; or, if there be much cerebral deter- 
 mination, we bleed from the arm, or draw blood from the temples 
 by leeches. 
 
 1427. Should irritation of stomach continue, and the legs and 
 feet become cold, much good is frequently derived by blistering 
 the legs, or from having them rubbed with mustard and warm 
 vinegar, Cayenne pepper and warm brandy, until the action of 
 the skin be excited. But from what has been said it will appear, 
 that our chief reliance is upon the use of the calomel. We arc 
 aware that many respectable practitioners are in the habit of 
 giving larger doses of this article than we are: be it so — we are 
 not at present, however, disposed to change a plan that has for 
 so many years borne us out successfully in this truly fatal dis- 
 ease. Let every practitioner proportion his doses agreeably to 
 
Or CHOLERA INFANTUM. 423 
 
 his own experience; the administration of this remedy is all we 
 are solicitous about. If one practitioner have found this remedy 
 to succeed best in larger doses, let hirn employ them; we are 
 satisfied with its efficacy in more minute quantities. We all 
 have the same object in view, namely, to quiet the irritation of 
 stomach and bowels, and to make a decided impression on the 
 hepatic circulation, to invigorate or calm its actions, and thus 
 restore the lost equilibrium in the distribution of the blood, which 
 is essential to the performance of its natural functions. 
 
 1428. Having thoroughly evacuated the prims vise, and re- 
 established healthy secretions, we are to desist from purges: we 
 should be content with keeping the bowels in a soluble state only ; 
 unless we have evidence of re-accumulations of bilious, and fouler 
 contents, or of hepatic torpor and congestion, when the same 
 course is to be renewed. But if irritation be excessive, and, as 
 usual, productive of frequent and painful discharges, we may, 
 with much advantage, administer anodyne injections, three or 
 four times in the course of the twenty-four hours, after having 
 applied a few leeches to the region of the stomach. These re- 
 medies will, in most cases, certainly calm the intestinal canal; 
 and as soon as this happens, the acrid discharges, together with 
 the other symptoms, very generally cease to be troublesome. 
 Yet it will be occasionally necessary to administer a mild purga- 
 tive, to remove oppressive accumulations, when they manifestly 
 exist: for this purpose, castor oil is best. 
 
 1429. In addition to what has already been advised, for the 
 management of this disease, w 7 e should be attentive to the means 
 calculated to make a direct impression on the skin. For this 
 purpose, the occasional use of the warm bath is highly impor- 
 tant. Every case of cholera, as formerly stated, is more or less 
 marked by great inequality of temperature — so much so, that 
 one portion of the body will be parching hot, while another is 
 very cold. By immersing such a patient in warm water, we 
 equalize temperature, and diffuse a glow over the entire surface, 
 while other benefits are, at the same time, attained. The effects 
 
 <of the bath, however, are not lasting ; and hence, it is required 
 to be repeated daily, or even oftener. It may be rendered more 
 effectual, where there is much cutaneous insensibility, by adding 
 to it salt, mustard or brandy — and, upon coming out, to employ 
 frictions, &c. 
 
424 OF CHOLERA INFANTUM. 
 
 14^0. We have already glanced at the use of blisters. They 
 are serviceable at any stage of the disease if unequal tempera- 
 ture prevail ; and may be applied over the stomach, abdomen, or 
 to the extremities, according- to the state of the case, and the 
 more striking indications, that is, if- the extremities be as warm 
 as the abdomen, we may apply a blister over the region of the 
 stomach ; but if the legs be cold, blisters had better be applied to 
 the calves of the legs, first irritating the surface by rubbing them 
 with a little spirits of turpentine. In addition to their ordinary 
 effects, they very usually promote perspiration. It is a fact not 
 sufficiently known, that without vesication, in certain conditions 
 of -the skin, diophoresis will not take place. 
 
 1431. This plan, however, proving unsuccessful, it must be 
 intermitted ; and, the bowels continuing highly irritated, with 
 hloody evacuations, we may try the oleaginous mixture, consist- 
 ing of castor oil, gum Arabic, and laudanum — or what, perhaps, 
 Is still better, melted hutter, or a union of sugar of lead, ipeca- 
 cuanha, and opium. The lead here is occasionally very efficacious. 
 
 1432. In the course of a few days, in some instances, and in 
 others, a week or more, the disease passes into the nature of diar- 
 rhoea, which, however, is sometimes attended by a slight degree 
 of tormina and tenesmus. It is also usual, at this time, to find 
 the stomach greatly debilitated, with a loss of the power of di- 
 gestion; and so irritable, as hardly to retain any description of 
 nourishment. At this time, also, the stools are apt to become 
 •very watery and green ; manifesting the predominance of acid. 
 The remedies proper, under such circumstances, consist chiefly 
 «of the cretaceous and alkaline preparations, variously combined 
 
 1433. They may be prescribed as follows: — 
 
 R. 
 
 B. 
 
 Cret. Prep, vel Test 
 
 . Ostreor. 
 
 3iss. 
 
 Gum Arab. ) 
 Sacch. Alb. j 
 
 
 ~t 5 t\ 
 
 
 ad 3> 
 
 Tinct. Theb. 
 
 
 ■gtt. X. 
 
 Aq. Font. 
 
 
 giij. M. 
 
 Sal. Tart, vel Carb. 
 
 Sod. 
 
 gr. xxx. 
 
 Gum Arab. ) 
 Sacch. Alb. 1 
 
 
 . 
 
 
 aa 5J- 
 
 Tinct. Theb. 
 
 
 gtt. x. 
 
 -Aq. Font. 
 
 
 §iij. M. 
 
OF CHOLERA INFANTUM. 425 
 
 A drop of the oil of cinnamon may be advantageously added 
 sometimes to either form of the mixtures. Lime-water and 
 milk may be, also, usefully employed. 
 
 1434. At this period of the disease, preparations of rhubarb 
 are sometimes resorted to with advantage. The spiced or sim- 
 ple sirup of rhubarb, may be given, combined with small doses 
 of laudanum. In the use of these preparations, the dose is to be 
 small, and repeated at stated intervals, so as to attain rather the 
 tonic, or astringent, than the purgative effect, of this medicine. 
 
 1435. As the disease advances, it loses most, or all of its acute 
 or painful symptoms, and becomes a colliquative diarrhoea; and 
 so profuse as to produce from ten to twenty stools in the twenty, 
 four hours. 
 
 1436. The treatment of this case is similar to that of chronic 
 diarrhoea; we shall only here point out some of the remedies 
 suited to the cases of children. (See Chapter on Diarrhoea.) 
 
 1437. Combinations of chalk, with the tincture of kino, or with 
 an infusion of galls and laudanum, are worthy of confidence. 
 The columbo in infusion, has much reputation. An infusion of 
 logwood has also been employed. The decoction of the pome- 
 granite bark, or flowers, is said to be of great service. The dose 
 of each of these preparations, is nearly the same— about a dessert- 
 spoonful to children above a year old, and less for younger. A 
 strong infusion of the dew, or blackberry root is said by many 
 to be useful; it has never done much in our hands. By some 
 practitioners, the chalybeates are not a little prescribed — the best 
 of which, agreeably to Dr. Chapman, is the supersaturated sul- 
 phate of iron, in the following formula: — 
 
 R. Sal. Martis. 
 
 g r - u- 
 
 Acid. Sulph. dilute. 
 
 gtt. X. 
 
 Sacch. Alb. 
 
 3J- 
 
 Aq.Font. 
 
 3j. M. 
 
 The dose3j. 
 
 1438. Even here, however, calomel is serviceable, when there 
 are marks of hepatic congestion, or want of bilious discharges, 
 or the presence of vitiated humours. But the chalybeate must 
 be laid aside, if it be proper to use the calomel; and the bitter 
 infusion be given instead. 
 
 1439. Exactly under similar circumstances, and especially if 
 the mucous tissue of the bowels be much disordered, as is mani- 
 
 54 
 
426 , OF CHOLERA INFANTUM. 
 
 fested by the loaded tongue and slimy stools, the spirit of tur- 
 pentine has been found highly beneficial. With this we have 
 several times succeeded, where all hope had been abandoned. 
 The dose is from five to twenty drops three or four times a day, 
 in sweetened cold water. Before we dismiss this part of our 
 subject, it may be well to observe, the occasional use of lauda- 
 num, when there is pain, is absolutely necessary; a flannel roller 
 around the abdomen, is sometimes productive of signal benefit. 
 
 1440. This brings us to the consideration of regimen. In the 
 commencement of the disease, the diet should consist exclusively 
 of breast milk; which is of such importance, that a nurse ought 
 to be procured, where the child has been weaned. It will of it- 
 self, sometimes cure the disease. Caution, however,' is neces- 
 sary, even here, as the child, from excessive thirst, may demand 
 the breast too frequently, and thus overload its stomach; the 
 child therefore must not be permitted to suck too much or too 
 often. If thirst be importunate, cold gum Arabic water may be 
 given in small quantities frequently, instead of the often nursing.* 
 But if the child will not take the breast, let it be fed on diluted 
 sweetened milk, or barley, or rice water and milk, or gum Ara- 
 bic tea. These will serve also for drink. But balm, or marsh 
 mallows tea, soda water, and burnt bread and water, may also be 
 directed for this purpose. In the advanced stages the farinaceous 
 articles may be employed — as very thin arrow root, tapioca, 
 sago, rice, or boiled flour. Extreme debility of the stomach 
 and bowels existing, and no fever present, a little ham or salt 
 fish may be allowed. Yet the only remedy which is sovereign, 
 and nearly unfailing, is a change of air. As long as the child re- 
 mains in the city, and exposed to the operation of ,the causes of 
 the disease, we may palliate or suspend its career, but can hard- 
 ly ever make a radical cure — relapse upon relapse takes place, 
 till the strength is finally extinguished. 
 
 1441. Great benefit is gained by a removal to the country, 
 in every stage of the complaint. It is even said by the late Dr. 
 Rush, that he never lost but three patients, where this advantage 
 was commanded; and it must be admitted, that there is nothing 
 so effectual. As soon, almost, as the child gets into the country 
 
 * For the purpose here signified, an ounce of gum Arabic will be sufficient for 
 a pint of water. 
 
OF HOOPING-COUGH. 427 
 
 air, we may discover a change. Where we cannot have a coun- 
 try residence, entirely, it will be useful to ride out daily, or 
 twice a day. Crossing the river, we have very often found high- 
 ly beneficial. 
 
 1442. To prevent a disease so difficult of management, and so 
 destructive of life and happiness, we shall indicate those mea- 
 sures which common experience has found best. 
 
 1443. 1. Never permit a child to be weaned within the year, 
 when practicable to prevent it. No food is so salutary as the 
 natural milk. As respects this complaint, weaning always pre- 
 disposes to its attacks. 
 
 1444. 2. Direct the wearing of flannel next to the skin, and 
 worsted stockings. The great benefit of this system, is expe- 
 rienced by grown persons, prone to intestinal complaints, and 
 we know its utility to be no less in children. 
 
 1445. 3. Duly regulate the diet — let an excess of any fruit be 
 avoided, and absolutely abstain from unripe or unwholesome 
 kinds. The proper food of a child is, substantially, milk with 
 farinaceous matter, such as arrow-root, rice, biscuit, &c. After 
 a few months, provided it has teeth, it will be useful to accus- 
 tom it to a little animal food. It strengthens the powers of di- 
 gestion, and the general tone of the alimentary canal. 
 
 1446. 4. During dentition, let the gums be frequently ex- 
 amined, and if any appearance of swelling or inflammation ex- 
 ist in them, they must be lanced. Dentition, during hot wea- 
 ther, is but too apt to excite cholera; and if the complaint exist, 
 it never fails to aggravate it. (See Chapter on Dentition.) 
 
 1447. 5. Let the child, when practicable, be removed to the 
 country; but not too early in the season. • 
 
 CHAPTER XXIX. 
 
 OF PERTUSSIS, OR HOOPING-COUGH. 
 
 1448. Hooping-cough usually begins like a cold, with more 
 or less fever, and* catarrhal defluxions — these continue, in some 
 instances, throughout every stage of the complaint; while, in 
 
428 OP HOOPING-COUGH. 
 
 others, they cease in a few days. The onset of the disease, is, 
 for the most part, abrupt, without any distinct febrile movement, 
 and is sometimes early attended by the peculiar inspiration, 
 which gives it its common name. At other times, a considerable 
 period elapses before this takes place; and, in some cases, it does 
 not happen. Cullen tells us, he has had instances of a disease 
 '• which, though evidently arising from the chin cough contagion, 
 never put on any other form than that of common catarrh." 
 
 1449. The disease becoming confirmed, the paroxysm consists 
 of a number of short expirations, closely following each other, 
 so as to produce a sense of suffocation: to overcome this, a vio- 
 lent effort of coughing is made, which usually ends in vomiting, 
 or a discharge of phlegm or mucus from the lungs. In many 
 cases, when the paroxysm is over, there is complete relief in the 
 interval ; so much so, that the individual seems not at all affect- 
 ed, except, perhaps, temporarily a little weakened. 
 
 1450. This complaint is not accompanied by a difficulty of 
 breathing as a necessary attendant, unless in such as may have 
 a chronic affection of the thoracic viscera. If it attend hooping- 
 cough in such as have no pectoral complaint ordinarily, it be- 
 trays, for the most part, some latent mischief in either the 
 bronchial membrane or the substance of the lungs themselves — 
 this may be either inflammation or engorgement. 
 
 1451. Dr. Watt says, that hooping-cough is sometimes attend- 
 ed with great torpor of the bowels, requiring large and frequent 
 doses of medicine before it can be overcome. We have never 
 witnessed this condition; and when it does occur, it is, perhaps, 
 only relative; the coats of the stomach and bowels being "var- 
 nished," as it were, with mucus ; and thus preventing the opera- 
 tion of medicine, by not permitting contact between the medi- 
 cine and the intestinal membrane. Also that the urinary secre- 
 tion is influenced, and micturation produced. 
 
 1452. In the commencement, expectoration is sometimes very 
 deficient; the cough is hard and dry; the paroxysms recur fre- 
 quently, and are long continued. Congestion of the lungs now 
 takes place; which produces, by the interruption of the circu- 
 lation in these organs, a correspondent state of the head ; and, as 
 a consequence, a turgescence and suffusion of face, amounting 
 sometimes even to lividity, which is occasionally relieved by 
 
OF HOOPING-COUGH. 429 
 
 gushes of blood, from the mouth, nose, eyes, or ears. In this 
 manner, the disease runs an indefinite course, from one month 
 to three, or even twelve months; though the average is, per- 
 haps, the second period. This, however, very much depends 
 on the season of the year ; it being always of longer duration in 
 winter. The popular notion is, and which is not far from the 
 fact, that it is six weeks in reaching its height, continues for 
 some time with but little abatement, then declines, and goes off 
 in six weeks more. 
 
 1453. Some writers, especially Webster, consider the hoop- 
 ing-cough as consisting in some cerebral disorder; and adduce, 
 as evidence, the existence of headach, redness of the eyes and 
 cheeks, and the relief that a bleeding at the nose affords, toge- 
 ther with the appearance of the brain and its appendages after 
 death. Dr. Gregor} 7 , like Webster, speaks "of a tensive pain 
 of the forehead; and, in severe cases, this is obviously an urgent 
 symptom, and one which demands attention in reference to prac- 
 tice." We have paid considerable attention, ever since we read 
 Mr. Webster's paper on hooping-cough, to the symptoms which 
 particularly mark this disease, but we have. never satisfied our- 
 selves of the existence of any prima?~y cerebral disorder. We 
 have occasionally had confessions from our patients, that they 
 had more or less headach, especially after violent coughing; 
 but there is surely nothing in this more than might be expected 
 from such efforts of the chest as this disease demands. And of 
 the "tensive" pain in the forehead just spoken of, we have 
 never been certain that it existed even late in the disease. This 
 may have arisen from our patients, at least nineteen out of twen- 
 ty whom we have examined with this view, being too young to 
 either describe it, or to make them sensible of our meaning; 
 with the few whom we interrogated that could comprehend what 
 we suppose Mr Webster intended by the expression, it was cer- 
 tainly wanting. Nor is the relief experienced by a bleeding 
 from the nose any proof of the existence of the disordered condi- 
 tion of the brain and its appendages ; since this kind of bleeding 
 very certainly removes pain from the head, when the mucous 
 membrane of the frontal sinuses are inflamed in catarrh. Be- 
 sides, the existence of the appearances after death, noticed by 
 Mr. Webster, does not appear to be confirmed by Laennec. And 
 Dr. Watt says that this disease is proved by dissection to be 
 
430 OF HOOPING-COUGH. 
 
 bronchitis. Guibert considers hooping-cough as "essentially 
 nervous or spasmodic:" he says, " with several authors, I look 
 upon the convulsive cough as a nervous disease, produced by a 
 spasmodic affection of the glottis and diaphragm. But this spasm 
 is seldom uncombined or idiopathic; and that in the majority of 
 cases it is coincident with some other affection of the organs of 
 respiration, as bronchitis, pneumonia, pleurisy, and sometimes 
 phthisis. In a word, the hooping-cough is a disease essentially 
 nervous or spasmodic, and which may exist alone, and without 
 any evident cause, but is generally attended by a disease which 
 has, for the most part, its seat in the respiratory organs, and 
 which necessarily modifies the progress, duration and mode of 
 treatment of the hooping-cough so decidedly, as to induce the 
 belief that it is the only existing cause. From this it would fol- 
 low, that all the idiopathic diseases which may have cough as a 
 prominent symptom, may also be attended by hooping, which 
 will then appear to be nothing more than a peculiar modification 
 of the ordinary cough. My opinion is founded, first, upon the 
 diversity and contradictory theories of authors upon this subject, 
 and which start with the assumption, that the disease is situ- 
 ated in this or that organ; 2dly, in this disease being compli- 
 cated, for the most part, with some other disease; 3dly, from the 
 uncertainty of any mode of treatment, and the similarity of re- 
 sult from opposite modes of treatment; and, 4thly, upon clinical 
 observation, and the inspection of the bodies of those who have 
 died of the disease," (pp. 145, 146.) 
 
 On this account of M. Guibert, we see nothing but an attempt 
 at new views, without the slightest practical advantage; and the 
 whole of his hypothesis upon this disease, is, in our opinion, 
 contradicted by the fact, that, as a general rule, it never occurs 
 but once in the same individual, which would not be the case, 
 were his opinion justly founded. 
 
 The same may be said of Dr. Alderson's pathology of this 
 disease — he makes it consist in an inflammation in the air cells 
 of the lungs; in which he says, " Mucus is secreted in less quan- 
 tity than usual, a fibrinous exudation takes place, and adhesion 
 of the parietes of the cells is the consequence; whilst the cellu- 
 lar membrane separating the individual lobules, retains its natu- 
 ral structure." ^ (Medico-Chirur. Trans., published by the Me- 
 dical Chirurgical Society of London, vol. XVI. part I.) 
 
OF HOOPING-COUGH. 431 
 
 Now, the inflammation spoken of, no doubt, in most instances, 
 really exists — but bronchitis, for it is nothing more nor less, sim- 
 ply considered, is not sufficient to account for the whole of the 
 phenomena of the hooping-cough, as we have this moment in- 
 timated of M. Guibert's views. 
 
 1454. With respect to the origin of pertussis, there is consi- 
 derable doubt. It is supposed to depend on a specific contagion, 
 which affects persons only once. To this, however, there may- 
 be exceptions. While it is pretty generally admitted, that the 
 disease proceeds from contagion ; there are writers who main- 
 tain, that it occasionally, at least, prevails as an epidemic; and, 
 hence, must originate in a more common source. Much discus- 
 sion has lately taken place on this point; but the facts are not 
 sufficiently numerous, nor well authenticated, to warrant any 
 very positive conclusion. 
 
 1455. Yet, we confess, that we are inclined to believe that it 
 depends on causes of a more general and pervading influence 
 than contagion. 
 
 1456. That it does, in some instances, arise from other causes 
 than contagion, seems quite certain. Willis, who was the first 
 to describe it accurately, declares it to be an epidemic, occur- 
 ring most commonly in spring and autumn. By Hoffman, it is 
 said to have spread in Berlin to a great extent, in the same way. 
 In the tenth volume. of the Medical Repository of New York, 
 Dr. Willey gives an account of the disease having suddenly bro- 
 ken out in Block Island, and where it prevailed widely, with- 
 out the inhabitants of the place having had any intercourse 
 with an infected source. It is a rule, with few or no exceptions, 
 that, where a disease can be traced to atmospherical influence, 
 it does not prove contagious. Nature, indeed, can hardly em- 
 ploy two such opposite causes to produce the same effect.* 
 
 * It is a well known fact, that many become affected, where every precaution 
 is taken to avoid contagion; and that the disease is uniformly relieved, or even 
 cured by a removal beyond the limits of the supposed distempered atmosphere. 
 
 Agreeably to Desruelles, the following writers have described epidemic hoop- 
 ing-cough: — 
 
 Traite de la Coqueluche, p. 100, &c. &c. 
 
 Pasquier speaks of an epidemic of this kind, that broke out in March, 1411. 
 More than one hundred thousand in Paris alone, were attacked with it. This 
 account is confirmed by Mezeray. 
 
 De Thou relates another epidemic that besieged Paris in 1510: this was called 
 
432 OF HOOPING-COUGH. 
 
 1457. Believing that the complaint is generated by specific 
 contagion, we have, perhaps, too much neglected to look for 
 other causes of its production. Yet, on the whole, in the present 
 state of our knowledge, it will be most prudent to proceed in 
 practice, under the impression of its contagious nature. 
 
 . 1458. It may be inferred from the history of the disease, that 
 the diagnosis is neither difficult nor obscure. But this is not 
 exactly so; for in its commencement, it so much resembles the 
 common catarrh, that it is almost always mistaken for it; espe- 
 cially in early spring, and late autumn: nor can it well be de- 
 cided which disease it may be, until the permanency and obsti- 
 nacy of the affection declare it to be hooping-cough. 
 
 1459. The remote cause of hooping-cough maybe received 
 at the moment catarrh is about to make its appearance; and thus 
 may be confounded with it; or it may be called into action by 
 the catarrhal affection, and thus perpetuate the symptoms of this 
 disease. Or it may, and we believe it often does, at the periods 
 just named, assume all the forms of catarrh, and from which, in 
 the commencement, it would be impossible to decide, whether 
 the affection under consideration be hooping-cough or catarrh: 
 for hooping-cough, at its onset in the spring and fall, is attended 
 by as much febrile action as catarrh; and it is not until this in- 
 flammatory stage is about to pass away, that the cough assumes 
 the paroxysmal form, and declares the disease to be hooping- 
 cough. When the spring is pretty far advanced, and during the 
 hot weather of summer, hooping-cough is rarely confounded 
 with catarrh ; for at these periods, there will be less fever, and 
 the disease will more quickly betray its peculiar character. 
 But, fortunately, no evil can arise from their being confounded; 
 for at this period their treatment must be precisely the same. 
 It also resembles the initiatory symptoms of measles; for in 
 hooping-cough there is sneezing, watery eyes, swelling of 
 
 hooping-cough: the symptoms were not related by him, though mentioned by 
 Sennertus. 
 
 Riverius mentions one that spread over almost the whole of Europe in 1557. 
 
 Baillou gives an account of one in 1578. 
 
 Geller describes one that took place in 1757, in the duchy of Mechlenburg. 
 
 Aaskow, one that happened at Copenhagen, 1775. 
 
 Arand, one that occurred at Mayence in 1769, &c. &c. 
 
 It thus appears that this disease has occasionally appeared in an epidemic form 
 from 1411 to 1815. The last, that is, of 1815, is said to have occurred at Milan. 
 
OF HOOPING-COUGH. 433 
 
 the eyelids, and an unusual fulness of the face. But the doubts 
 to which of the diseases these symptoms belong, is, for the most 
 part, soon cleared up, by the eruption taking place in measles on 
 the third or -fourth day after the commencement of the catarrhal 
 affection. It is, however, said, that instances of measles have 
 occurred without any eruption having taken place, but this we 
 have never seen. 
 
 1460. This disease is generally most severe with infants, as 
 they cannot expectorate with the sam.e freedom as older children, 
 and are thus debarred this source of relief. Where it attacks 
 with much fever and catarrh, it is also unfavourable; and with 
 pneumonia, or peripneumonia notha, still more so. Consumptive 
 subjects rarely or never recover. The favourable circumstances 
 are — absence of fever, and oppression ; free expectoration, and 
 facility of vomiting. The disease terminates sometimes, by the 
 gradual wasting of strength, or runs into chronic affections, as 
 consumption, asthma, hydrothorax, and hydrocephalus, or, sud- 
 denly, by apoplexy, or suffocation, from spasm of the glottis. 
 
 1461. It is obvious, that the irritation of the remote cause, 
 wherever it may be primarily seated, induces an inflammation of 
 the mucous membranes of different parts of the organs of respi- 
 ration, occasioning an increased secretion of fluid ; which accu- 
 mulating, acts as an extraneous substance, and brings on the 
 cough for its expulsion. When this natural effort succeeds, there 
 is for a time a complete interruption of the coughing: but on its 
 being reproduced, we have a repetition of the paroxysm. By 
 too long a continuance of this irritation, disorganization takes 
 place in the lungs, &c; and the system at large, participating in 
 the morbid affection, a gradual exhaustion of strength, and death 
 takes place ; or the air-cells being choked up, or the glottis closed 
 by spasm, or by collections of mucus, or lymph, the patient dies 
 suddenly from suffocation:. or, possibly, in some instances, as is 
 represented, the brain may become so affected as to constitute a 
 new and more complicated case, terminating life by coma, con- 
 vulsions, &c. At this period, an inflammatory state of the sys- 
 tem undoubtedly exists; it, however, exhibits a very peculiar 
 character, owing, perhaps, to the nature of the cause by which 
 it is excited; for it, unquestionably, is far less obedient to the 
 usual remedies than ordinary inflammation ; and, in many re- 
 
 55 
 
434 OF HOOPING-COUGH. 
 
 spects, proves illustrative of the modification which this condi- 
 tion receives, from the agent producing it. 
 
 1462. Dr. Watt regards this disease as essentially an inflam- 
 mation of the mucous membrane of the bronchia; and that when 
 it terminates fatally, it is generally by the production of severe 
 bronchitis. Laennec says, that hooping-cough holds a middle 
 place between the mucous catarrh and pituitous catarrh, as far as 
 regards the nature of the expectoration and the bronchial con- 
 gestion ; but that it possesses some characters peculiar to itself. 
 Such rarely occurs twice in the same person; the cough taking 
 place by fits: " Each fit," he says, " is composed of a quick suc- 
 cession of sonorous coughs, with scarcely any perceptible inspi- 
 ration between ; except that, from lime to time, the expirations 
 of coughing are suddenly interrupted by a very deep, seemingly 
 convulsive, and noisy inspiration, accompanied by a lengthened 
 hissing, which constitutes the pathognomonic sign of this variety 
 of catarrh." " The stethescope exploration of the chest in the 
 intervals of the fits, supplies only the usual results of catarrh — 
 namely, a feebler respiration than natural, or the complete ab- 
 sence of this in certain points, which, however, sound well — pu- 
 erile respiration in other parts, and, occasionally, a slight sono- 
 rous or sibilous mucous rattle." 
 
 1463. Desruelles makes it consist of an inflammation of the 
 bronchia, complicated with cephalic irritation. But that the " in- 
 flammation des bronches est toujours primative, et l'irritation du 
 cerveau consecutive," p. 77. We can readily imagine that the 
 brain, or its appendages, may indirectly become implicated with 
 hooping-cough, since the very efforts of the thorax, during the 
 paroxysms, is well calculated to force an unusual quantity of 
 blood into the brain — we, therefore, need not be surprised, that 
 dissections have revealed water in its ventricles, though we can- 
 not admit, that the inflammation which terminated by the effu- 
 sion of water, was the cause of the affection of the lungs.* Des- 
 
 * Dr. Palmer (Illustrations of Medicine, p. 183) has adopted the following pa- 
 thology. He says, "During, the violent paroxysms of the cough, the blood is 
 propelled in undue quantity and with increased impetus to the brain; and the ir- 
 ritated and loaded organ reacts with augmented violence on the local malady. 
 Numerous facts are illustrated by this view in the history of chin cough. Of these, 
 the most striking are — the absence of the convulsive character in the other imflam- 
 mations of the air passages not complicated with cerebral irritation; — the exist- 
 
OF HOOPING-COUGH. 435' 
 
 ruelles considers hooping-cough as essentially inflammatory, 
 under all its modifications and appearances. He says, u a quel- 
 ques causes que puissent etre attributes les modifications que 
 presente la coqueluehe; quelles que soient Pactiviteou la lenteur 
 de sa marche la violence ou la faiblesse de ses symptomes ? la 
 promtitude ou le retard de sa guerison, son etatde simplicite ou 
 de complication, son issue heureuse ou funeste, cette affection 
 offre toujours les caracteres d'une maladie inflammatoire dont 
 les difierens degres sont les principales causes des formes di- 
 verses qu'elle revet," p. 217. 
 
 1464. Notwithstanding a more correct light has been shed 
 on the pathology of hooping-cough, little new is proposed in 
 the management of it. 
 
 1465. As the whole of the phenomena at the commencement 
 of this disease declare it to be catarrhal; and as in most in- 
 stances, in the cold part of our seasons, it is attended with fever, 
 and marks of local irritation and inflammation, there is the most 
 decided necessity for treating this complaint by evacuants; as 
 blood-letting, laxatives, and emetics, and these to be repeated 
 according to the exigency of the case. These should be perse- 
 vered in until they produce direct evidence that the inflamma- 
 tory stage of the disease is abated, or subdued; or, in a word, 
 let the disease, in the first instance, be considered nothing more 
 than a violent catarrh, and be treated accordingly. 
 
 ence of the cerebral symptoms invariably observed even in the mildest form of 
 chin cough; — the frequency of nasal hemorrhage, and the marked relief of the 
 bronchial affection resulting from it; — the notorious tendency of the brain to ac- 
 tive disease in hooping-cough; from which some writers have been erroneously led 
 to infer that the latter is simply a cerebral affection,- — and lastly, the maintenance 
 of the convulsive character long after every trace of the original inflamatipn of 
 the respiratory membrane has dissapp eared ;f and the final removal of the disease, 
 at that period by spinal irritants, powerful moral impressions, or other agents 
 which can exert no direct influence upon the bronchial membrane, or any other 
 organs, except the spinal marrow and the brain." 
 
 j- This clearly explains one of the sources from which error has arisen in in- 
 vestigations of the morbid anatomy of chin cough. A child is destroyed by an 
 affection of the brain, connected with the disease in its later stages; and, conse- 
 quently, after every visible trace of the bronchial inflammation has disappeared. 
 On dissection, the bronchial membrane is found in a natural condition; and hence, 
 an apparently correct, although erroneous inference may be drawn, that a morbid 
 state of this membrane constitutes no essential character of hooping-cough. 
 
If- $30 OF HOOPING-COUGH. 
 
 1466. We are persuaded, that this disease oftentimes becomes 
 inveterate, and sometimes dangerous, from prescriptions being 
 based upon a mistaken pathology. Thus, both Burton* and 
 Millarf reject blood-lettirfg altogether, though Millar sometimes 
 ventured upon the application of leeches. LieutaudJ never 
 employed it but in extreme cases; that is, when the fever was 
 very violent and the respiration difficult, &c. We would there- 
 fore, wish the reader to keep in mind, the opinions of Laennec, 
 Desruelles, Watt, and others, that in hooping, the bronchia or 
 other portions of the lungs are sure to be in a state of inflam- 
 mation, especially in its commencement ; and if proper depletion 
 be neglected, a second stage is formed of the disease, and we 
 then find a disposition, to either metastasis to the brain, or find 
 that it participates severely with the original complaint — hence, 
 convulsions, inflammation of the brain, or hydrocephalus, are 
 found to supervene. 
 
 1467. Bleeding is demanded, in many instances, independ- 
 ently of other circumstances, by the interrupted circulation of 
 the lungs; and affords, almost always, the most decided relief.§ 
 And this must be repeated as the necessity for it may continue, 
 or, as this necessity may subsequently return to the progress of 
 the case. Even in Europe, where the lancet, comparatively, is 
 so sparingly employed, this practice is commanded, and gene- 
 rally pursued ; but in this country, its employment, for the most 
 part, is indispensable. 
 
 146S. This was the practice of Willis, who was the first to 
 give a regular account of this disease ;|| he chiefly relied, for its 
 cure, upon vomiting, purging, and blistering. This appears, too, 
 to have been the general practice of the age, and particularly 
 of Sydenham; and we have, among many inferior names, those 
 of Astruc, Huxham, Hoffman, Hillary, Home, Lettsom. &c, 
 }n favour of this course of treatment. 
 
 1469. Evacuations of the alimentar}^ canal must also be 
 brought in aid of bleeding; and these may be made by eme- 
 
 * Appendix to Treatise on the Non Naturales. 
 f Observations on the Asthma and Hooping-Cough. 
 t Med. Prat. 
 
 § By bleeding-, we wish to be understood, taking blood from the general sys- 
 tem by means of the lancet. 
 II This was in 1664. 
 
OF HOOPING COUGH. 437 
 
 tics, or laxatives ; of the latter, the best is castor oil, after the 
 bowels have once been opened by calomel. The former are 
 chiefly applicable to children; and, where the attack is violent, 
 and the oppression great, they may be repeated, provided the 
 accumulation of phlegm is great and threatening. To keep up 
 the impression on the stomach, small doses of the syrup of squills, 
 or ipecacuanha, should be given in the intervals. Or, what has 
 answered all these intentions with the most decided efficacy, is 
 Coxe's hive sirup, given in proper doses. 
 
 1470. We always have recourse to this medicine immediately 
 after bleeding, (if this have been necessary) and after having 
 purged with calomel, hive sirup must be given in such doses as 
 shall freely promote expectoration; or, should there be oppres- 
 sion, or evidence of great accumulation of phlegm in the wind- 
 pipe and lungs, in such quantity, as shall freely puke. We, for 
 the first purpose, order doses suitable to the age of the child, 
 every hour or two, as it may show its effects. For a child of 
 three or four months old, we would order eight drops every 
 hour or two, and a proportionally larger quantity as the age ad- 
 vances; and, for the second view, we would give these quanti- 
 ties every fifteen minutes, until an emetic operation be pro- 
 duced. Let it be, however, remembered, that children of the 
 same age will bear very different quantities of this medicine, as 
 well as of every other; therefore, the doses must be constantly 
 regulated by the effects. After this medicine has operated as an 
 emetic, it must be given, as before directed, as an expectorant* 
 But should bleeding not have been necessary, the case will 
 rarely require more than demulcent drinks, and a low diet. 
 
 1471. The state of the expectoration is a matter of conse- 
 quence, and should always be attended to; for from it much may 
 be learnt. After the disease, in favourable cases, has arrived at 
 
 * The following-, is the recipe for making- the compound simp of squills, or 
 
 Coxe's hive sirup. Take of 
 
 Seneca snake-root, bruised ~) , . ir , 
 
 „.„,., ' . , £ each half a pound. 
 Squills, dried and bruised 3 
 
 Water - - - eight pounds. 
 
 Boil tog-ether, over a slow fire, till the water is half consumed; strain off the 
 liquor, and then add of strained honey four pints. 
 
 Boil the honey and strained liquor to six pounds, or to the consistence of a si- 
 rup; and, to every pound of the sirup, add sixteen grains of tartar emetic; that is, 
 one grain to every ounce. 
 
438 " t)F HOOPING-COUGH. 
 
 its height, or is upon the decline, the expectoration becomes 
 more profuse, and the sputa lose their mucous character, by as- 
 suming a more purulent appearance. But if this take place sud- 
 denly, or in the early part of the disease, it is, for the most part, 
 an unfavourable sign. Nor is blood mixed with the expectorated 
 matter, a good token, generally speaking. 
 
 1472. The most abstemious diet should be observed during 
 the whole of the catarrhal stage of this complaint, which is from 
 three to six weeks, according to the season. Children at the 
 breast should receive nothing but the mother's milk; those who 
 are weaned should be confined strictly to a milk and vegetable 
 diet. All animal food, or broths, must most scrupulously be 
 avoided. Itennet whey is preferable to whole milk. The drinks 
 should be barley water, flax-seed tea, gum Arabic water, bran 
 tea, toast water, or molasses and water. 
 
 1473. The milder laxatives, though recommended by many, 
 do not answer as well as calomel for the first purging; for inde- 
 pendently of its purgative effects, this medicine would seem to 
 exercise some other power. Certain it is, that active evacuations 
 by calomel, in the commencement of the disease, have, in a 
 greater or less degree, the effect of breaking down the force of 
 the catarrhal symptoms, and to abridge the career of the disease. 
 We, therefore, almost always commence the treatment with a 
 mercurial purge; and repeat this for the first two or three days, 
 if the .condition of the bowels require it. Whatever opinion 
 may be adopted of its mode of action, we are certain of its util- 
 ity; and as there can be no dispute as to the propriety of having 
 the bowels well opened in the beginning of the disease, calomel 
 seems to be the best suited to this purpose. 
 
 1474. During the general treatment pointed out, we are not 
 wholly to loose sight of some local remedies in this disease. 
 Congestion and inflammation of the lungs are apt to take place; 
 for the relief of which, blisters are found decidedly advanta- 
 geous after proper evacuations ; or, should it be necessary to 
 draw more blood, let it be done by leeches or cups, from be- 
 tween the shoulders. We are decidedly of opinion, that blood 
 cannot be taken by leeches or cups, with any thing like the 
 same advantage from any other part, where there is a threatened 
 congestion of the lungs; and it sometimes becomes important 
 to follow this up, by a blister to the same part. 
 
OF HOOPING-COUGH. 439 
 
 1475. When there is a strong determination to the head, the 
 same remedies are required, both general and local. Leeches to 
 the temples we have found of singular advantage, where much 
 pain in the head was experienced after each spell of coughing; 
 indeed, we now never neglect this last symptom, as we are con- 
 vinced it was the prelude to a fatal issue in two or three cases we 
 have seen by extravasations within the brain — and who has not 
 witnessed the advantage, or at least the immediate relief, from an 
 accidental bleeding at the nose! 
 
 1476. Though we admit of determination of blood to the head 
 in this disease, and recommend, as just stated, local depletion for 
 its relief, we are by no means of opinion, that either this deter- 
 mination, or an inflammation of the brain, or its appendages, 
 has the least agency in the production, or even the perpetuation 
 of the cough with which either may be associated. Yet the su- 
 pervention of inflammation, or even a congestive state of the 
 brain, will very much increase the danger of the patient — there- 
 fore, these conditions require the active means just recommended 
 for their relief. Nature sometimes furnishes the means of relief 
 herself, by instituting a bleeding from the nose — this, when suf- 
 ficiently extensive, affords more relief than either cupping or 
 leeching, and should, therefore, always be encouraged to an ex- 
 tent every way compatible with the exigency of the symptoms, 
 and the strength of the patient, if this be practicable. 
 
 1477. But let it be remembered, that the bleeding from the 
 nose, however instrumental and speedy it may be in abating the 
 violence of the marks of determination to the head, or of con- 
 gestion in the brain, only proves the immediate condition of 
 these parts, and not an original agency, in the production of 
 hooping-cough. 
 
 1478. In the use of the remedies recommended above, we 
 would wish it to be understood, that we do not always prescribe 
 bleeding, or loss of blood in any other way in every case of 
 hooping-cough, as it very often presents itself without the symp- 
 toms which would justify this, or, perhaps, any other remedy, 
 except occasionally the use of the sirup, as just directed, to se- 
 cure a free expectoration: or the administration of a few grains 
 of calomel; or, what is better, after the first few days of the dis- 
 ease, the occasional use of castor oil, if the bowels be confined. 
 
 1479. If due regard have been paid to the treatment of the in- 
 
440 OF HOOPING-COUGH. 
 
 flammatory or catarrhal stage of hooping-cough; or if the reme- 
 dies for subduing this state have been successful; a second pe- 
 riod of this disease will arrive, in which other remedies may be 
 useful. But it should be carefully ascertained before the cha- 
 racter of the remedies are changed, that every vestige of inflam- 
 matory action shall have ceased ; therefore, the pulse must be 
 carefully examined, and it must be found sufficiently subdued, 
 before we commence with the antispasmodic and tonic remedies. 
 
 1480. Desruelles finds much fault with these directions: he 
 says, "comment se fait-il que le Docteur Dewees, qui montre tant 
 de confiance dans le regime, qui 3e prescrit avec tant de reserve 
 et de sagesse, ait cru necessaire de donner l'emetique, d'entrete- 
 nir les nausees par des petites doses d'ipecacuanha, de purger 
 souvent avec calomelas, et de s'abandonner a l'action incertaine 
 et souvent nuissible des narcotiques, des antispasmodiques, et 
 meme des toniques? II preconise la saignee et la diete, et il ad- 
 ministre des medicamens stimulans: n'est-ce pas detruire d'une 
 main se que l'on a fait de l'autre? Par quelle etrange association 
 d'idees peut-on faire concpurir au meme resultat des moyens si 
 opposes, si contradictories?" (p. 242.) 
 
 1481. In answer to the above questions, it will be only neces- 
 sary to say that we differ a little in the progressive pathology 
 of hooping-cough, and on this circumstance does the difference 
 of our treatment arise. Desruelles considers the bronchia, at 
 least, if not the brain or its appendages, to be in a state of phlo- 
 gosis during the whole continuance of the cough; while we are 
 of opinion that the stage of inflammation passes away, and that 
 if the cough continue after the pulse declares the absence of fe- 
 brile action, that it arises from some impression upon the ner- 
 vous system, or that it may then become the cough of habit. 
 With this belief in view, we prescribe a rigid diet, order bleed- 
 ing, either general or topical, or both, purging, &c; but, after the 
 necessity for this discipline has ceased, we think we have always 
 found it useful to give antispasmodics, or tonics. 
 
 1482. We do not order, as will be perceived, these different 
 plans at one and the same time ; for we have just insisted, that 
 " before the character of the remedies is changed, we should 
 carefully ascertain that every vestige of inflammatory action has 
 ceased." There is certainly no inconsistency in this practice — 
 nay, it is very often essential to the cure of many affections, as 
 
OF HOOPING-COUGH. 441 
 
 fevers, and especially intermittents, that the system be reduced 
 before tonics are given. We have just stated, that Desruelles 
 looks upon the hooping-cough to be essentially: an inflammatory- 
 disease, under all its modifications, and through the whole of its. 
 career, and that it consequently requires an antiphlogistic treat- 
 ment from its commencement to its final departure, but as we 
 have never had any reason to be of this opinion ourselves-, we 
 have not adopted the notions of this author upon this point. 
 The difference of our views of the character of the disease during; 
 its progress, will readily account for the difference of our plans. 
 of treatment. We might retort his queries with equal propriety 
 to him, when he insists upon one uniform mode of practice 
 through the whole course of the disease; for to us it appears as 
 inconsistent as our plan does to him. 
 
 1483. In justice, however, to him, we admit that we have seen 
 a number of cases of hooping-cough subdued, and that speedily, 
 in some instances, by a perseverance in the antiphlogistic plan 
 of treatment; but, on the other hand, in justice to ourselves, .we 
 must say that we have seen very many more, that required the 
 treatment that we have laid down. 
 
 1484. We believe it has been chiefly owing to want of atten- 
 tion to the state of the pulse, that this disease has not yielded 
 more generally to the influence of remedies — for it has been pre- 
 scribed for more empirically, than almost any other complaint in 
 the long catalogue of human diseases. Should the first stage have 
 been neglected, or improperly treated, the disease will pursue its 
 course in spite of all opposition ; and the patient may be felicitated 
 when it takes its departure, however protracted this may be, 
 and leaves not behind, more serious evils than were experienced 
 by its presence. 
 
 1485. We have no confidence in the opinion, that this disease 
 will have a determined course ; and that we can only relieve the 
 pressure or inconvenience of the immediate symptoms, though it 
 is urged by Sydenham himself. Nor should we inculcate this 
 belief, until it be a well ascertained fact, as it would but too cer- 
 tainly foster supineness and indifference in the treatment of this 
 formidable disease. Too much has already been taken for grant- 
 ed upon this subject ; and, because we are not yet in possession of 
 proper counter agents to this complaint, it certainly does not 
 prove it to be indomitable, T^he intermittent fever, and lues 
 
 50 
 
442 OF HOOPING-COUGH. 
 
 venerea, were once thought to be equally, if not more unmanage- 
 able, than hooping-cough; but the discovery of the bark,and 
 the use of mercury, have rendered them comparatively harmless 
 diseases; the proper or appropriate remedy for hooping-cough 
 may, therefore, be yet discovered. 
 
 1486. If the opinion prevail, that hooping-cough will have a 
 definite duration, all exertion to abridge its career will be para- 
 lyzed, and the poor suffering infants and children will be deprived 
 of even the moderate aid it is now in our power to give. As re- 
 gards ourselves, we are decidedly of opinion, that its duration 
 may be as certainly shortened, as the march of fever; nor do 
 we say this upon slight or inadequate grounds, if our observations 
 have not deceived us. We have known this disease to be made 
 run its course in eight members of the same family, and at 
 the same time,, in less than six weeks ; and in many other in- 
 stances, the period has been abridged with equal success. But 
 what has entirely confirmed us in the persuasion, that the pe- 
 riod of this disease can be shortened, nay, even stopped short 
 in some instances, was the success we once witnessed from the 
 exhibition of the tincture of artificial musk, in a family of five 
 children, who were all labouring under confirmed hooping- 
 cough. 
 
 1487. When we prescribed this remedy, the disease had been 
 of about two weeks' standing, all the children were attacked 
 within the period of a week ; the catarrhal symptoms were very 
 mild; it was summer, and they readily yielded to a moderate 
 antiphlogistic plan. All inflammatory action was completely 
 subdued, and all the children were put upon the use of the arti- 
 ficial musk at the same time. One, the youngest, (eleven months 
 old,) ceased to cough altogether in less than a week, and neither 
 of the others continued as long as a fortnight. 
 
 1488. We, however, confess we have not seen so-striking an 
 instance of the influence of this article since; though we are every- 
 way convinced, it is a valuable remedy in this disease, and one 
 that we have long been in the habit of using. 
 
 1489. Another disadvantage arising from the belief that this 
 disease cannot be shortened, is the neglect of early measures to 
 subdue, or moderate the inflammatory action of the system in its 
 commencement; in consequence of this, cerebral, and pulmonic 
 congestions form, of which the patient, perhaps, speedily dies,. 
 
OF HOOPING-COUGH. 443 
 
 or such disorganization takes placs as to render him miserable 
 for life. This doctrine is not understood by people in general — 
 for when it is declared we cannot abridge the period of the dis- 
 ease, it is always understood to mean, we can do no good in 
 hooping-cough; of course, the physician is but too rarely em- 
 ployed in this complaint. Yet we are certain, there are few dis- 
 eases, in which more relief is experienced than well treated 
 hooping-cough in the commencement: of this opinion also was 
 the experienced Dr. Underwood, who declares, " There is no 
 complaint of children, with which I am acquainted, in which 
 medicine is at times more evidently serviceable, than in bad 
 hooping-cough." Then, why should poor children be aban- 
 doned, in this formidable complaint, for an ill-sustained hypo- 
 thesis, or popular belief? 
 
 1490. Narcotics, and antispasmodics, are also directed at this 
 period of the disease : among these, opium claims our first notice. 
 After evacuations have been duly made, and there is a proper 
 abatement of fever, or other marks of irritation, its use^as a pal- 
 liative of the more troublesome symptoms, is sanctioned by the 
 ^experience of almost every body. The pleasantest, and we be- 
 lieve, the best form for its exhibition, is in the brown mixture, 
 in suitable doses at night* Dr. Edwin P. Atlee recommends, 
 with much confidence, the Prussic acid. The following is his 
 formula: — 
 
 R. -Acid Hydrocyanic, gut. iv. 
 Syr. Simp. |ij. M. 
 
 A tea-spoonful, morning and evening, for the first day — three 
 times a da}'- after. — American Journ. of Med. Sciences, for May, 
 1332. 
 
 * The following- is the Formula for the brown mixture^ so called from its co- 
 lour: — 
 
 $u Elix. Paregor. ^j. Take Paregoric Elixir 1 ounce. 
 
 Vin. Antimon. gss. Antimonial Wine £ ounce. 
 
 Sue. Glycrrh. giij. Liquorice Ball 3 drams. 
 
 Pulv. G. Arab. gij. Gum Arabic 2 drams. 
 
 Aq. Fervent. ^vj. M. ft. sol. Hot water 6 ounces. 
 
 Mix. 
 Of this, a child from four months to six, may take a small tea-spoonful every two 
 'or three hours during the night, should the cough be troublesome. One from 
 six months to a year, a large tea-spoonful and repeat, if necessary — one, from on 
 to two years, a dessert-spoonful, and repeat; one from two to four, a table-spoon* 
 •ful, and so on, as the age increases. 
 
444 OF HOOPING-COUGH. 
 
 And Dr. Bland gives the sulphuret of potash in this disease. 
 He advises it in doses of ten grains, morning and evening, in a 
 little honey. — lb. 
 
 1491. During the prevalence of the pathology, which ascribed 
 the disease to spasm, antispasmodics were the chief remedies. 
 Of this class the whole were tried in succession, and particularly 
 the castor, artificial musk, and asafoetida. Of the powers of the 
 former, we are entirely ignorant, having never prescribed it. 
 Cullen, however, tells us, that it is of no value. 
 
 1492. The second, or artificial musk, has been long in use in 
 Spasmodic affections; and its powers are, in some degree, ascer- 
 tained. But it is only within a few years, that it has been em- 
 ployed for the cure of pertussis; and we have already said, we 
 have found it oftentimes a valuable remedy. 
 
 1493. It is also highly estimated by Underwood ; and espe- 
 cially where the spasms are violent: it is given in the dose of 
 fiveor six drops on sugar, or highly sweetened milk. 
 
 1494. Of the antispasmodics, asafoetida has always borne a 
 high character; but our own experience is, by no means, calcu- 
 lated to advance the reputation of its powers in the disease in 
 question ; though we have found it occasionally useful, but never 
 decidedly efficacious. 
 
 1495. We are next to consider the proper plan, after the cause 
 of the disease, whatever it may be, has worn itself out, or is dis- 
 missed, and when the cough is kept up by the force of habit 
 only; to interrupt the train of morbid associations, all the tonics 
 
 "have been directed, and especially such as are supposed to have 
 the effect of subduing paroxysmal tendencies. The Peruvian 
 bark was, of course, placed at the head of this class, and is much 
 .celebrated. Cullen bestows on it unqualified praise, and con- 
 siders it by far the most certain means ; and even says, when 
 given in sufficient quantity, he has seldom seen it fail of speedily 
 putting an end to the disease. It is reasonable to suppose, that 
 the bark might be useful ; though it must be confessed that we 
 have not witnessed such striking results from it; and, on account 
 of the difficulty of getting children to take it with regularity, it 
 is rarely prescribed in this city. 
 
 1496. This objection, however, does not apply to the sulphate 
 of quinine; and it deserves a fairer trial than we suspect it has 
 received. We have employed it in. only one case; but this was 
 one of the most forlorn kind — it produced almost resuscitation. 
 
OF HOOPING-COUGH. 445 
 
 I 
 
 1497. Mr. Sutcliff combined the bark with cantharides, and 
 'administered it with great success, he says, in 'hooping-cough. 
 The following is his formula : — 
 
 R. Tinct. Cort. Pern v. ^vj. Take of the Tinct. of bark 6 ounces. 
 Elix. Paregor. ~ss. Paregoric Elixir | ounce. 
 
 Tinct. Canthar. 3j. M. Tinct. of -Canthar. 1 dram. 
 
 Mix. 
 Of this mixture, small doses were given three or four times a 
 day, gradually increasing until a slight strangury was excited; 
 and then the dose was diminished, or taken at longer intervals. 
 The strangury would generally take place about the third day; 
 and the hooping-cough seldom continued above six days from 
 the first exhibition of the medicine. It, however, succeeded 
 sometimes without exciting any strangury, though it generally 
 produced its salutary effects sooner, when that circumstance 
 came on, whether the bark was joined by the cantharides or not. 
 
 149S. Dr. Lettsom says, that *' during twenty years this in- 
 genious practitioner has almost constantly continued to use this 
 medicine with the most nattering success." Dr. Lettsorn being 
 desirous to know whether Mr. Sutcliflf's more mature experience 
 led him to place the same confidence in this remedy, wrote 
 certain queries to him respecting chin cough. 
 
 1499. Mr. S. replied to these several queries, and concluded 
 by remarking, "I never yet saw an unsuccessful event after 
 using the composition of bark, ^cantharides, &c, having never 
 lost a patient in the hooping-cough." Dr. L. declares that si- 
 milar success attended his own trials of this medicine. Watt, 
 p. 282. 
 
 1500. But we have never employed any remedy, of equsl 
 efficacy with the garlic in substance, to relieve the cough of 
 habit, after hooping-cough. We have very often used it; and 
 we -have rarely seen it fail. The objections arising from its 
 smell are, however, very strong in the minds of some; so much 
 so, that they cannot be prevailed upon to use it. But children 
 of six or seven years of age, or even older, can very often be 
 prevailed upon to eat it, and become after awhile very much at- 
 tached to it. A child of six or seven, may begin by taking a third 
 of a common-sized clove, morning, noon, and evening; gradually 
 increasing the dose, as the system becomes accustomed to its 
 action. One, of ten, may take half a clove three times a day; 
 increasing^ as'mayjDe necessary; and so on for greater ages, 
 
440 OP HOOPING-COUGH. 
 
 1501. Desruelles again condemns us for the employment of 
 the garlic, both externally and internally. Indeed, he goes so 
 far as to say, " we have a blind confidence in this substance." 
 This affects us not; and so long as we continue to experience 
 benefit from it, we shall persevere in recommending it, under 
 the restrictions suggested above; namely, in the absence of all 
 febrile excitement, and where the cough appears to be perpetu- 
 ated by habit. The following case is highly deserving of atten- 
 tion: Miss M. W., aged twelve years, had the hooping-cough 
 in great severity, notwithstanding she was subjected to very ac- 
 tive treatment in the early or inflammatory stage of the disease. 
 It began in March, and the cough continued with great violence 
 until July, at which time we were requested to prescribe for her. 
 At our first visit, we had an opportunity of witnessing two fits 
 of coughing; both of which spells exceeded in severity any- 
 thing we had ever seen. She was literally black in the face, 
 and was threatened with immediate suffocation. These par- 
 oxysms were repeated frequently, especially during the day; 
 they left her weak and exhausted; she lost flesh daily, and was 
 so debilitated, as scarcely to be able to walk. She was ordered 
 to eat a small clove of garlic three times a day; in forty-eight 
 hours these paroxysms left her entirely; a slight cough remained 
 for a few days, and then ceased altogether. We cannot but be- 
 lieve it was the garlic which afforded such speedy and happy 
 relief; particularly as it has frequently proved as certainly, if 
 cjiotas extensively, serviceable in other cases of hooping-cough. 
 
 1502. Exactly on the same principle, the arsenical solution is 
 •employed; and we have the strong testimony of Simmons and 
 Ferriar in support of it. Each of these writers goes so far as to 
 declare, that it is the only medicine deserving of much confi- 
 dence. On this point, we can say nothing from our own ex- 
 perience; as we do not deem the few trials we have given this 
 medicine entitled to much weight, our impressions of its ef- 
 >ficacy are not strong. 
 
 1503. We have said nothing of the utility of topical remedies, 
 in the acute stage of the disease; for they can rarely be useful: 
 but in the one now under consideration, external applications 
 may be advantageously resorted to; such as liniments of an irri- 
 tating nature, as the volatile, or the camphorated; the spirit of 
 turpentine, mixed with olive oil; or the juice of garlic, rubbed 
 along the vertebral column. But,above all, we think we have ob- 
 
OF HOOPING-COUGH. 447 
 
 served more advantage to result from the use of the tartar eme- 
 tic ointment,* than from any other external application — this 
 should be applied high up between the shoulders. 
 
 1504. It is well understood, how much the action of the lungs 
 is dependent on a nervous influence from the spinal marrow; and 
 it is probably on this principle the efficacy of such embrocations 
 is to be explained. The muscles of the chest, diaphragm, and 
 scapulas, receive portions of the cervical, and dorsal nerves; the 
 accessory nerves of Willis form a part of the par vagum, and 
 assist in giving rise to the cardiac and pulmonalic plexus ; hence, 
 the propriety of applications to the spine; and, hence, the popu- 
 lar opinion of the utility of a Burgundy pitch plaster between 
 the shoulders, is accounted for, from anatomical arrangement. 
 
 1505. Of the efficacy of a change of residence, more particu- 
 larly to the country, and even a frequent exposure to fresh 
 air, every one is so fully persuaded, that the remedy is abused, 
 by its general and indiscriminate adoption. It is by no means 
 uncommon to see children exposed, in the coldest and most in- 
 clement seasons; and this, sometimes, by the orders of the at- 
 tending physician. Nothing can be more pernicious, and ilr- 
 judged. 
 
 1506. In the inflammatory catarrh, we guard against cold, by 
 keeping the patient in a room duly warmed ; the same should: 
 be observed, in the first stage of the hooping-cough. The lungs^ 
 in this case, are either inflamed, or peculiarly susceptible of in- 
 flammation — so that the slightest exposure brings on, renews*, 
 or violently exasperates the attack. Catarrh, or active peripneu> 
 mony, superinduced on pertussis, constitutes a most formidable 
 case, and most frequently is the way in which the disease proves 
 obstinate, or fatal. But, the inflammatory stage having passed, 
 and the weather mild, much advantage may be derived from 
 gentle exercise in the open air — this may be by walking, of 
 riding in a carriage. But, completely to eradicate the disease,, 
 the child should be removed into the country, provided the sea- 
 son of the year will justify this change. 
 
 * The following formula, we are in the habit of using- for children: — 
 §<. Tartar. Antimon. giss. 
 
 01. Lavend. vel Ess. Lem. gtt. xv. 
 
 Cerate Simp. ^j. M. 
 
 With this the part indicated must be rubbed three times a day, until it shows a 
 number of small pimples upon it— dress with common cerate. 
 
44S OF CYNANCHE TONSILLARIS- 
 
 CHAPTER XXX: 
 OF CYNANCHE TONSILLARIS. 
 
 1507. This disease comes on with huskiness, and next with 
 pain and inflammation of the throat, attended by some difficulty 
 of deglutition, and sometimes with fever. In a short time, these 
 are increased; and from the swelling of one, or both tonsils> 
 there is a great inability to swallow. If the throat be examined 
 at this time, we shall find the uvula, the pharynx, and the 
 neighbouring parts extremely. red-, and excessively tender. 
 
 1508. It, however, in some instances, and especially where 
 the individual has had many preceding atacks, shows itself as a 
 mere local affection, without fever, or any general constitutional 
 disturbance. 
 
 1509. In this form of the disease, we have phlegmonous inr 
 flammation, which terminates, usually, either by resolution, of 
 suppuration, and sometimes by induration of the glands. But, 
 in other cases, it puts on the appearance of erysipelas; and here, 
 instead of red vivid inflammation, with much swelling, the as- 
 pect is dark or purple; with superficial vesicles, or ulcers, of a 
 white or gray colour, resembling ordinary aphthae. 
 
 1510. Commonly, no- species of this disease is dangerous* 
 whatever may be the degree of the immediate suffering .;. and it 
 only becomes so, when the inflammation extends to a more imr 
 portant structure, as the larynx. 
 
 1511. The symptoms, however, sometimes run very high, and 
 then great suffering is endured. For the tonsils become so en- 
 larged and engorged, that they nearly fill up the posterior fau- 
 ces. Deglutition is now extremely difficult, and sometimes air 
 together impossible, without a repetition of the greatest and 
 most painful efforts. Under such circumstances, it is not unr 
 usual for cough to be excited, and drive whatever is attempted 
 to be swallowed through the nostrils. The faucial extremities 
 of the Eustachian tubes are very apt to be involved in this in- 
 flammation: when this is the case, each attempt to swallow is 
 followed by an acute darting pain through the course of the 
 tubes, which seem3 to terminate in the external ear. 
 
OF CYNANCHE TONSILLARIS. 449 
 
 1512. One of the most troublesome symptoms against which 
 the patient has to contend, is the free secretion of a very tena- 
 cious mucus; this quickly accumulates in sufficient quantity to 
 force the patient to swallow it; on which attempt, the pain be- 
 comes so excessive as to produce a convulsive action of almost 
 every muscle in the body. This secretion is particularly trou- 
 blesome when the patient attempts to sleep — so much so, indeed, 
 sometimes, as almost to preclude the possibility. To obviate 
 this as much as possible, the patient should make his mouth so 
 depending, that it may flow out before it accumulates in such 
 quantity as will oblige him to swallow. The whole of the mus- 
 cles of the fauces and tongue partake so much of the inflamma- 
 tion, that it is impossible sometimes to protrude it; and the effort 
 is always attended with pain. The tongue is quickly incrusted 
 with a thick, very white coat. 
 
 1513. The fever which accompanies the cynanche tonsillaris 
 is sometimes very high; at others very much less than we 
 should suppose would attend an inflammation of such extent and 
 apparent violence. With those who are liable to attacks of sore 
 throat, the fever for the most part is moderate — indeed, in some 
 instances, it seems to decline in proportion to the frequency of 
 the occurrence, as if the system had lost some portion of its 
 sympathizing powers. We, however, know of but few diseases 
 which leave so much debility in the same time behind it. This 
 may, perhaps, in part, be accounted for, from the entire impossi- 
 bility, sometimes, of taking down nourishment. 
 
 1514. This disease is occasionally very obstinate; the inflam- 
 tion not advancing to suppuration, nor receding by resolution. 
 This is especially the case with those who may have cynanche 
 supervene upon enlarged tonsils ; or in those who have the lym- 
 phatic temperament strongly marked. 
 
 1515. Cynanche tonsillaris is almost exclusively produced by 
 exposure to cold. There are many persons peculiarly liable to 
 it; and a predisposition seems to be especially given, by former 
 attacks; hence, caution is required, in avoiding the exciting 
 cause. 
 
 1516. The practice of washing the throat every morning with 
 cold water, is said to be an exellent preventive, and we know 
 that much advantage has been derived from gargling the throat 
 
 57 
 
450 OF CYNANCHE TONSILLARIS. 
 
 every morning and evening with a solution of alum, for the same 
 purpose. 
 
 1517. The treatment of the disease divides itself into that 
 which is proper in its forming state; and into that, at the subse- 
 quent stages. 
 
 151S. If we are called very early, and before diseased action? 
 be completely established, we may frequently check the attack, 
 by a stimulating gargle — such as an infusion of Cayenne pepper;* 
 and by rubefacients, as the spirit of turpentine, mustard and vi> 
 negar, applied to the external surface of the throat, until the 
 skin becomes inflamed; or even by warmth, when the attack is 
 very recent and mild, as a piece of flannel, or a worsted stock- 
 ing tied around the neck. But should these fail, we must 
 change the practice, and endeavour to reduce the inflammation 
 by evacuations. An emetic is here exceedingly efficacious, ge- 
 nerally resolving the swelling, and suppressing the fever, if such 
 exist; this should be succeeded by a mercurial purge, to be 
 worked off, and the bowels kept open, by the saline laxatives. 
 
 1519. If necessary, we must next resort to blood-letting; and 
 especially leeching the throaty but the state of the pulse must 
 always govern the use of these remedies. In many cases, it is 
 not at all demanded; particularly general bleeding, as it is rarely 
 productive of as much utility as might be expressed. Yet, where 
 there is great vascular action, it must be employed and repeated 
 according to the emergency. The topical bleeding, by cups, or 
 leeches, is generally more effectual;, and especially where the 
 affection is local, or the system is somewhat reduced. In vio- 
 lent cases, or even in cases threatening to be violent, blisters- 
 should be employed; and this as early after the leeching as pos- 
 sible. 
 
 1520. Gargles, in this state of the disease, are always detri- 
 mental ; as they aggravate the inflammation, by the violent and 
 inverted action which they induce. As a palliative, a mixture of 
 equal parts of nitre and loaf sugar, finely powdered, occasionally 
 put on the tongue, and, as it melts, allowed to trickle over the 
 
 * Take a tea-spoonful of Cayenne pepper, pour on it a gill of boiling' water, 
 stir for a couple of minutes, and then let it settle clear— let the throat be gargled 
 with a portion of it every four hours, 
 
OF CYNANCHE TONSILLARIS. 451 
 
 inflamed surfaces, is oftentimes highly serviceable; as is also 
 the stream of water, or vinegar and water, applied by Mudge's 
 inhaler, or, as a substitute, a common tea-pot. 
 
 1521. But should the disease obstinately run its course to sup- 
 puration, (which may be known by the surface becoming of a 
 yellowish hue, and by the throbbings and disposition to rigour,) 
 they may, in urgent cases, be opened. With this view, emetics 
 were formerly employed. But the practice is painful and unne- 
 cessary, as it may be readily done by puncture. Having dis- 
 charged the matter, mild detergent gargles, as sage tea, honey, 
 and vinegar, should be directed, to eleanse the parts, and dis- 
 pose them to heal kindly. 
 
 1522. As regards the erysipelatous species of the disease, the 
 treatment is somewhat different. We rely more on topical 
 bleeding, and the vesicatory applications; and where aphthae or 
 sloughs appear, on stimulating gargles; and, in the event of ex- 
 treme debility supervening, the system is to be supported by 
 bark, wine, the carbonate of ammonia, and whatever else enters 
 into the treatment of putrid sore throat. 
 
 1523. If due attention, however, be paid to the forming stage 
 of this disease, it can very frequently be arrested in limine: for 
 this purpose, stimulating external applications are, for the most 
 part, efficient. The spirit of ammonia, of turpentine, or a mix- 
 ture of the flower of mustard and vinegar, are the best. They 
 should be applied immediately over the throat, and should be 
 permitted to remain, until they produce decided irritation : they 
 may be repeated when this effect disappears. 
 
 1524. To such children as are subject to this affection, the 
 above directions are highly important; and subsequent returns 
 may often be prevented in those that can gargle, by a" perse- 
 vering use of alum water, or an infusion of nut galls, in the pro- 
 portion of half an ounce of the powder to a pint of boiling wa- 
 ter, and then simmered for a few minutes. This must be strained 
 off, and used early in the morning, and on going to bed. We 
 have found the following better in warm weather than the one 
 just suggested. Pour half a pint of brandy or whisky, and as 
 much water, upon an ounce of powdered Aleppo galls, and shake 
 them several times a day for a few days — let it then settle, and 
 pour off the infusion for use. With a quantity of this the throat 
 should be gargled the first thing in the morning, and the last at 
 night. 
 
452 OF MUMPS. 
 
 CHAPTER XXXI. 
 
 CYNANCHE PAROTIDE, OR MUMPS. 
 
 15*25. This disease consists in an inflammation of the parotid 
 glands, of the phlegmonous kind. It is often confined to one 
 side; though more generally to both ; sometimes the maxillary 
 glands are also implicated, and hence, the swelling of the jaws. 
 
 1526. For the most part, this is a disease of but little moment; 
 especially if it occur in the warmer season of the year. But 
 at other times, there is much constitutional disturbance. Ri- 
 gours, followed by much fever, sometimes happen, especially 
 during the variable weather of early spring. The first sensa- 
 tion of inconvenience, is about the angle of the lower jaw: this 
 part presently becomes painful upon moving the head; a tumour 
 is now perceived at the part, which goes on to increase until the 
 fourth or fifth day; after which it gradually subsides, if not main- 
 tained by fever. It is not unusual for one side to be first af- 
 fected, and after this has nearly run its course, the gland upon 
 the opposite takes on inflammation, and also runs its course. 
 When this happens, the disease becomes more protracted and 
 painful. 
 
 1527. We have occasionally seen severe suffering from this, 
 complaint: this is in consequence of a high degree of inflamma- 
 tion, and an excessive enlargement of the gland. The jaws be- 
 come closed, and deglutition is performed with much difficulty. 
 The ears are now and then much pained, as in common ear- 
 ache. The stomach is sometimes annoyed by nausea, or dis- 
 turbed by vomiting; and irt some few instances, we have wit- 
 nessed excessive fever, and even delirium. 
 
 1528. When this complaint is unattended by much fever, its 
 progress is regular, and its termination favourable — in such case, 
 it is scarcely an object of medical discipline ; at most, it requires 
 but lenient purging, a low diet, and some mild topical applica- 
 tions, as warm sweet oil, or hog's lard, and the pained parts 
 kept warm, by flannel. Care, however, should always be taken, 
 even in the mildest forms of this disease, that the patient be not 
 exposed to the risk of taking cold ; as a remarkable peculiarity 
 
OF MUMPS. 458 
 
 attends this complaint ; which is, its disposition to metastasis, or 
 translation ; to the testes, in males, and to the breasts, in females ; 
 especially in adults. 
 
 1529. In the severer forms, however, of this complaint, ac- 
 tive measures are sometimes indispensable; bleeding to a con- 
 siderable extent we have occasionally found necessary; brisk 
 purging, and the most strict observance of an antiphlogistic regi- 
 men. 
 
 1530. Occasionally, we have been obliged to have recourse to 
 topical depletion by leeches, and this followed by warm cata- 
 plasms of bread and milk, to promote the farther discharge from 
 the bites of these animals. The mercurial purges appear to an- 
 swer best in this disease ; especially if their operations be pro- 
 moted by either of the neutral salts. 
 
 1531. Should a translation take place, it may be accompanied 
 by many distressing symptoms. In the male, we once saw the 
 testes prodigiously enlarged ; much suffering was endured, and 
 great hazard was incurred by the change. Violent fever, and 
 delirium accompanied this change of seat of the disease, and it 
 required a perseverance in very active remedies to subdue them. 
 
 1532. In the female, the breasts are the seats of the metasta- 
 sis: they sometimes enlarge very much, and become extremely 
 tender and painful ; but we believe they never run on to suppu- 
 ration. 
 
 1533. In the treatment of this complaint, under a change of 
 seat, regard should always be paid to the parts originally affected. 
 With this view, we have always blistered the parts immediate- 
 ly over the parotids, and, we think, with decided advantage. If 
 the change have taken place in the male, we also exhibit an 
 emetic, and apply warm vinegar by means of flannel to the scro- 
 tum, and this to be repeated from time to time. A brisk purging 
 should also be instantly instituted, after the operation of the 
 emetic is entirely over, provided it, and the blistering, have not 
 been successful in recalling the morbid action to the original seat 
 of the disease. 
 
 1534. In females, besides blistering and purging, (for with 
 them it is doubtful whether emetics are useful in this condition,) 
 we apply warm vinegar by means of flannels, as directed above, 
 to the inflamed breast. We have never seen any permanent evil 
 follow these translations : though several such are recorded by 
 authors, 
 
454 of croup. 
 
 1535. This disease, like several others, affects the system but 
 once; it is supposed to be contagious; but whether this be well 
 founded we are not prepared to say — it is almost always epide- 
 mic, at least, in this country; which may, with much propriety, 
 call in question its contagious nature. 
 
 CHAPTER XXXII. 
 
 OF CYNANCHE TRACHEALIS, OR CROUP. 
 
 1536. It is not essential to our purpose to inquire whether 
 this disease was known to the ancients, or is one of comparative- 
 ly modern origin. It is now sufficiently ascertained, that it is 
 one of too frequent occurrence in this, as well as in many other 
 countries; and, also, that it is one of too frequent danger. 
 
 1537. This complaint is almost altogether confined to the pe- 
 riod of childhood; and is most frequent in infancy, or before the 
 fifth or sixth year. It is affirmed, particularly by Cullen, that 
 this disease rarely attacks infants till after they are weaned ; 
 and that there is no instance of its occurring in children above 
 twelve years of age. As a general rule, this may be correct; 
 but our experience has furnished us with a number of excep- 
 tions. We have seen it in its most formidable shape, in children 
 at the breast ; and we have witnessed death from it in the adult.* 
 
 * " The croup chiefly prevails in children from a short period after birth, until 
 puberty, attaching itself to particular families." Cheyne, p. 15. To the truth 
 of these observations, we have frequently borne witness. But we have seen this 
 complaint after puberty, and in adult age, though Dr. Cheyne says, " I have heard 
 of no example of this disease after the fifteenth year." He says, farther, *I have 
 imagined this to depend on the change which happens in the constitution at pu- 
 berty, and, perhaps, in a more peculiar manner, in the change which the upper 
 part of the windpipe undergoes," p. 23. This is ingenious; and, probably, it is 
 owing to this circumstance that it is a rare disease in adult age? but that it occurs 
 even at late periods of life is certain. We have attended a lady within the last 
 six years, who is now upwards of forty, several times, (certainly five;) with threat- 
 ening attacks. M. Guibert is of opinion, that " various anatomical and physiolo- 
 
of croup. 455 
 
 1538. Children of a florid complexion, and enjoying high 
 health, and especially those inclined to be fat before two years, 
 are more obnoxious to it than those of an opposite temperament. 
 It is a disease of more frequent occurrence in some situations 
 than in others; and those which are near waters of great extent 
 are more exposed to it than children in inland situations; in a 
 word, where a cold, and moist air unite; and especially, when 
 it suddenly alternates, with a dry, warm, air. Nothing, perhaps, 
 can be more satisfactorily proved, than the agency of cold, moist 
 air, in the production of this complaint; especially in the spring 
 and fall. So much so, indeed, is this the case in certain situa- 
 tions, that the mothers of such children as may be disposed 
 to this disease, dread the prevalence of that wind, which shall 
 bring with it both. Thus, in this city, a north-east wind in 
 early spring, or fall, is almost sure to produce, or reproduce, 
 this complaint in those who are disposed to it. But, with such, 
 almost any sudden transition, which shall too suddenly arrest 
 perspiration, will be attended by the same consequences. 
 
 1539. Mechanical causes have produced a disease having all 
 the characters of croup from other causes; thus, Mr. Balfour in- 
 
 gical circumstances concur in rendering the croup more frequent in infancy, and 
 in giving it its distinguishing characteristics. v The principal of these are, 1st, 
 The straightness of the windpipe, and particularly of the glottis; 2dly, The great 
 sensibility of the mucous system in general, of which sensibility the membrane 
 lining the respiratory passages has its full share; 3dly, The extreme difficulty of 
 expectoration, at this age, a circumstance which favours the accumulation of mu- 
 cus in the windpipe, and consequently the obstruction of the bronchial ramifi- 
 cations; 4thly, The activity of the circulation, which readily explains the ready 
 occurrence of inflammations at this period of life, as well as the intensity of their 
 symptoms and the rapidity of their progress; 5thly, The abundance of matters 
 furnished by the secretions and exhalations, particularly those of the cutaneous* 
 and pulmonary transpirations, and of the mucous secretions of the air passages; 
 6thly, The close sympathy which unites these latter functions, a sympathy which 
 enables them mutually to support each other, and which occasions the increase 
 of action in the one, when the activity of the other is diminished; 7thly, The fine- 
 ness and softness of the skin's texture, the light clothing worn by children, their 
 imprudence in exposing themselves to cold when they are sweating profusely, 
 and becoming suddenly inactive after severe exercise." (Researches Nouvelles 
 et Observations Practiques sur le Croup et sur la Cocqueluche, &c p. 7. 
 
 As a prophylactic, we have been assured by Dr. Dupuy, that ten drops of spirit 
 of turpentine, morning and evening, have been found by Dr. Mettauer highly- 
 serviceable. 
 
456 of croup. 
 
 .formed Dr. Home, that he had " attended a child in a disease, 
 which from the similarity of voice appeared to him to be croup. 
 The child died. When opened, a piece of shell, which the 
 child had sucked in with its breath, was lying across the trachea, 
 about an inch below the glottis, and the membrane was inflamed 
 and dry." " Here," continues Dr. Home, "was an artificial 
 croup raised, from which we may evidently perceive how the 
 voice is altered in the natural disease."* 
 
 1540. This disease attacks in one of two ways: 1st, by a 
 hoarseness, which is perceived upon coughing, and which may 
 continue without increase, for even several days, or until, per- 
 haps, the sudden application of some exciting cause, as a change 
 in the temperature of the air. For exposure to cold and damp, 
 or a check of perspiration, is sure to call forth some of its more 
 formidable symptoms; as, more or less difficulty of breathing; 
 an increase of cough without expectoration, and fever: this form 
 is longer running its course, than the one about to be men- 
 tioned, but is less obedient to the powers of medicine. 
 
 1541. Or, secondly, it may attack with the most alarming 
 suddenness, where no such onset was suspected. When it is 
 thus prompt in its appearance, it menaces life from the moment 
 of its invasion ; and if its terrible march be not very speedily 
 arrested, it but too frequently triumphs in death. 
 
 1542. But whether the croup insidiously steal upon its vic- 
 tim, or suddenly threaten it ; the latter part of the evening, 
 after a short, but rather disturbed sleep, and about two or three 
 o'clock in the morning, are the most certain periods for it to de- 
 clare itself — hence, the frequency of our first attendance, during 
 the night.t 
 
 * Inquiry into the Nature and Cure of Croup, p. 49. 
 
 -j- Dr. Cheyne says, " The disease generally comes on in the evening", after the 
 little patient has been much exposed to the weather during the day, and often 
 after a slight catarrh of some days' standing," p. 15. The evening is the most 
 frequent period for an attack of this complaint? but for this purpose, it is not ne- 
 cessary that "the little patient " shall have been " much exposed to the wea- 
 ther;" for we have often witnessed this disease, from the mere prevalence of a 
 north-east wind, and where, in consequence of this wind, every precaution has 
 been taken to guard against its influence, by confining the child, and keeping it 
 warm. We have elsewhere declared, (1544) that catarrh is not a necessary fore- 
 runner of this complaint. 
 
op croup. 457 
 
 1543. With the exception of hoarseness, we have never ob- 
 served any premonitory symptoms to this disease; for we cannot 
 with propriety consider a slight catarrhal affection, as properly 
 belonging to this complaint, though they may occasionally pre- 
 cede the croupy symptoms. Cheyne's account is rather too poet- 
 ical for ordinary occurrence ; or, at least, we cannot acknowledge 
 we have ever # witnessed, (and our own family has furnished us 
 unfortunately with but too many examples,) that the patient 
 "shuns his play fellows, and sits apart from them, dull, and, as 
 it were, foreseeing his danger," p. 16. On the contrary, we have 
 seen many instances, where this disease has attacked children, 
 and that with great violence, after their having spent their eve- 
 nings in high mirth and merriment 
 
 1544. It must, however, be confessed, that we have known 
 children indisposed, and dull, from catarrh, previously to the at- 
 tack of croup; but, in these instances, the latter was not antici- 
 pated from any of the then existing symptoms; consequently, this 
 previous condition did not necessarily belong to, nor, strictly, 
 precede the latter. We believe it to be familiar to almost every 
 practitioner, that croup may supervene upon catarrh; not, per- 
 haps, ever as a consequence, but as a coincidence; for catarrh 
 is owing to a peculiar condition of the mucous membrane of the 
 nose and windpipe; and that croup may form, or grow out of this 
 affection, it will at least require an alteration of that condition, 
 and not a mere increase of its force; for in the severest catarrhs 
 we witness — catarrhs, which require not only prompt, but ex- 
 tremely active treatment, croupy symptoms do not make their 
 appearance, as a necessary consequence. In this opinion, we are 
 happy to find ourselves confirmed by an observation of the cele- 
 brated and accurate Laennec, whose work upon the diseases of 
 the chest has been lately most ably translated by Dr. Forbes. 
 He says, p. 120, "The false membrane which so frequently forms 
 on blisters, is, of itself, sufficient to prove that it is much less to 
 the degree than the nature of the inflammation, that we are to 
 attribute this concretion or coagulation of pus in certain cases. 
 Indeed, the cause of it is much more probably to be attributed 
 to some peculiar disposition of the fluids, than to any affection 
 of the solids." 
 
 1545. From this, it would appear, that it is not sufficient for 
 the production of croup, that the mucous membrane of the wind- 
 
 58 
 
45S OF CROUP. 
 
 pipe be merely inflamed; but that it requires a modification of 
 inflammation, to induce it. 
 
 1546. It may be farther observed, that during the prevalence 
 of catarrhal affections croup is more rife than at other periods; 
 not that the one produces the other (1544:) but because, during 
 such periods as the spring and fall, or the very moist and open 
 weather of winter, there is a stronger disposition created to these 
 diseases; and that they have, at one and the same time, the same 
 exciting causes. ' 
 
 1547. We have uniformly observed, the insidious approach of 
 this complaint, to be less under the control of remedies, if its 
 first stage be neglected, than when the attack is sudden, however 
 violent that attack may be. This is doubtless owing to its first 
 symptom, hoarseness, being neglected. For this reason, we 
 would wish to put parents upon their guard, whenever this symp- 
 tom may take place; and to assure them, from long experience, 
 that it is one of a most dangerous and threatening character. So 
 attentive have we been to this forewarning in our own family, 
 (and we have taught others to be equally vigilant,) that this symp- 
 tom was attended to immediately, and opposed by most active 
 remedies; and we have every reason to believe, that by the 
 means recommended for this purpose, we have stopped this for- 
 midable complaint in limine, in very many instances. It is true, 
 a hoarseness passes off sometimes without much mischief; but 
 this is not the hoarseness of croup ; for this, we believe, never 
 takes its leave spontaneously. 
 
 1548. The hoarseness, which disappears spontaneously, is very 
 distinct from that of croup; the difference, however, cannot well 
 be conveyed by wordsj unfortunately sometimes for those who 
 may be assailed by it.* This, however, may be observed, that 
 there is a certain clearness and distinctness in the croupy sound, 
 that does not attend the other; the one, (the croupy) seems as if 
 it issued from a metallic instrument; and the other, from one of 
 
 * Dr. Ferrier, observes, (Med. Hist. Vol. III. p. 137,) " Children who are sub- 
 ject to croup, are sometimes seized with a deep barking cough, which will 
 increase to such a degree as to create much alarm, about the usual time of the dan- 
 gerous exacerbation; yet it will decrease again, and at length go entirely off with- 
 out any other remedies than common demulcents. Cases of this kind, I suspect, 
 have been described as genuine paroxysms of croup ; and very trifling methods of 
 cure have been recommended, in consequence of their apparent efficacy in the 
 spurious croup, which always cures itself." 
 
of croup. 459 
 
 a less vibrating material. The ear, however, by long habit, may- 
 learn to distinguish between them ; and when once instructed in 
 this discrimination, never loses its tact. Again ; we may observe, 
 that the evanescent hoarseness is almost always accompanied by 
 a little soreness of throat ; while that of croup, we believe, never 
 is. Again; the first is perceived in common speaking ; whereas, 
 that of croup is only discernible, in the commencement, by 
 coughing. Lastly, some little pain and soreness are observed 
 about the posterior fauces, after coughing, in the one ; which ne- 
 ver happens in that of the other. It may not, however, be amiss 
 to observe, that a mere loss of voice must not be mistaken for 
 croupy hoarseness, as we have known it to be on several occa- 
 sions, to the great terror of an anxious parent. 
 
 1549. In this, and, perhaps, in every other country where croup 
 is of frequent occurrence, every sudden difficulty of breathing, 
 accompanied with cough, in children, is mistaken for it. Thus, 
 the acute pituitous catarrh is mistaken for it. Laennec says, 
 " This disease is characterized by an extreme oppression, attend- 
 ed by a copious pituitous expectoration. It sometimes begins as 
 a common cold ; but after a few hours, or even minutes, its se- 
 vere character is soon declared by the violence of the cough, the 
 intensity of the dyspnoea and oppression, the lividity of the face, 
 marks of cerebral congestion, disordered circulation, and cold- 
 ness of the extremities. In children it is sometimes mistaken for 
 croup."* 
 
 1550. But it may be proper to advise, whenever hoarseness 
 takes place, not to trust too much to the discriminating powers 
 of the ear, for its nature ; but instantly to proceed upon the sup- 
 position that it may be of a dangerous kind; especially as the 
 remedies employed for the one, will most certainly relieve the 
 other. It would, therefore, be erring on the right side, were we 
 to treat this hoarseness as if it were of a mischievous character, 
 though it might have passed away without such treatment. 
 
 1551. It would seem necessary to the well understanding of 
 the progress of croup, and its mode of treatment, that it be di- 
 vided into three stages ;| 1st, the forming stage; 2dly, the com- 
 pletely formed stage; and, 3dly, the congestive stage. 
 
 * Laennec on the Chest, Forbes' translation, p. 83. 
 
 ■\ Dr. Cheyne divides this disease into but two stages: 1st, "The incomplete, or 
 inflammatory;" and, 2dly, "the complete, or purulent." In the first, " the mem- 
 
 \ 
 
460 OF CROUP. 
 
 Of the First Stage. 
 
 1552. We have already remarked, (1548) that one of the first 
 and most certain signs of this complaint being about to take 
 place, is a peculiar sonorous hoarseness, when the patient coughs, 
 but which at this period does not affect the speaking voice; this 
 peculiarity exists for a longer or shorter time, without much 
 increase, even for several days, in some instances"; while in 
 others, the interval, or stage of formation, is very short, but 
 very decidedly marked. This hoarseness may in some instances 
 be accompanied or preceded by catarrhal symptoms, (1544) but 
 not necessarily.* In this stage, when not attended by catarrh,, 
 we find, for the most part, the circulatory system undisturbed,, 
 and the respiratory not confined, nor even hurried. The child r 
 generally, is as cheerful as usual ;. and its appetite, and digestive 
 powers are undisturbed. In a number of instances, where the 
 disease was making an insidious attack, we have seen children 
 exeFt themselves even pretty violently, without creating any un- 
 common hurry in the breathing, or occasioning the slightest em- 
 barrassment in it ; yet these very children, in the course of a few 
 
 brane is not yet formed, in the second, it is fully formed." This-division does not 
 comprehend the whole history of the disease? for the forming stage is one of the 
 greatest importance in the treatment of the complaint; and, therefore, merits, we 
 conceive, the distinction we have given it. Besides, we cannot regard Dr. 
 Gheyne's second stage as representing this disease in its complete form: since the 
 whole of the phenomena of that stage, are but consequences of the previous, or 
 his " incomplete, or inflammatory." And he himself admits this, in several places 
 ©f his lucid and excellent essay. M. Guibert divides the disease into, first, the 
 stage of irritation; 2dly, that of albuminous secretion*? and, 3diy, that of suffoca- 
 tion, or debility. 
 
 * " The inflammatory affection of the larynx, is, doubtless, sufficient to account 
 for the alteration which takes place in the sound of the voice and cough." 
 Cheyne, p. 22. We believe there is, in most instances, an intermediate condi- 
 tion of the larynx, in the commencement of this disease; which is a degree of ex- 
 citement in the part, accompanied by a little thickening of the mucous mem- 
 brane, but which do not absolutely amount to inflammation: for, could not hoarse- 
 ness be produced by any thing short of inflammation, there coulcTnot be that 
 species of croup, which Dr. Ferriar, and Dr. Cheyne himself, admit the existence 
 of, namely, the "spurious croup." (See note to par.. 1548.) We are farther 
 disposed to believe in this condition of the trachea, or larynx, in consequence of 
 the very speedy removal, in many instances, of this symptom, when sufficiently 
 promptly attended to, by the remedies recommended for the first stage of this 
 complaint. 
 
or croup. 
 
 461 
 
 more hours, were reduced to the last extremity; and some of 
 them did not escape with life. 
 
 1553. We think we have observed, however, in this forming 
 stage, especially in the insidious attacks, the hands to be more 
 than usually cold ; the face to be rather unnaturally pale; and 
 the skin to resemble, in a small degree, the cold stage of an in- 
 termittent, but not attended by a sense of cold ; this state of 
 collapse remains for several hours, in some instances, before the 
 system is roused to reaction. But where the attack is sudden, 
 we are by no means certain that this condition always precedes 
 the febrile state, which so frequently is awakened, and made to 
 accompany this complaint. 
 
 1554. During this period, however, the mucous membrane of 
 the nose is observed to be affected; since the secretion in the 
 nostrils is either arrested altogether, or very much diminished; 
 and continues to be so during the whole course of the disease, 
 unless it terminate favourably. The cough is short, dry, and 
 sonorous; or, if any thing be expectorated, it is thin and whitish, 
 and in very small quantities. If the throat or fauces be inspect- 
 ed, nothing unusual, (at least, as far as we have observed,) shows 
 itself. The back part of the tongue, is, perhaps, rather more 
 loaded than is natural, but it is far from being remarkable.* 
 
 1555. After the continuance of the above symptoms for a 
 longer or shorter time, a change takes place, by an aggravation 
 of all of them ; and, at the same time, others are added; and 
 these will constitute the 
 
 Second Stage, or that in uhich the Disease is complelehj formed. 
 
 1556. We now ouserve the hoarseness to be increased, and to 
 affect the speaking voice ;f that is, the tone of hoarseness is evi- 
 dently deeper, more ringing, and betrays itself in every attempt 
 
 * " When in the urgency of the attack, the fauces and neck are examined 
 with a view to investigate the cause of the symptoms, (hoarseness, &c.) even 
 when a sense of heat is complained of in the throat, the tonsils are not swelled, 
 and but little inflamed." Cheyne, p. 18. 
 
 f It may be remarked, as a general rule, that where the voice becomes sudden- 
 ly affected by hoarseness, which discovers itself in speaking, and without being 
 so in coughing, that it is not the hoarseness of croup. This kind of hoarseness,, 
 however, is more common to adults, than to children. 
 
462 of croup. 
 
 to speak ; the cough is more frequent, the spells longer, and a de- 
 gree of exhaustion, attended by an increase of the difficulty of 
 breathing, follows each effort; the face becomes flushed during 
 the coughing; but generally subsides as the circulation becomes 
 more equal, after the exertion, but leaves the cheeks, or, per- 
 haps, only one, redder than natural.* The circulation is now 
 much hurried, in most cases; at other times, it is very little dis- 
 turbed: when this latter is the case, the face is seldom flushed, 
 and the hands and skin of the extremities are rather below the 
 natural standard of heat. The child is drowsy, and falls into 
 frequent, but disturbed slumbers, from which it is generally 
 roused by the most heart-rending cough, and an increase of op*- 
 pression. The child raises itself up, if sufficiently old to do so ; 
 or, if not, elevates its head, with desire to gain air more freely. 
 This state of things does not last long; for, if the progress of the 
 disease be not arrested here, it marches with rapid haste to the 
 
 Third or Congestive Stage. 
 
 1557. At this period, the cough is attended with some expec- 
 toration, of a thin, or frothy mucus, which affords no relief: it 
 is more frequent in its recurrence, and more permanent in its 
 duration; sometimes so much so, as to threaten strangulation — 
 the child becomes much exhausted by these efforts, and throws 
 itself back as if in despair; but from which it instantly springs, 
 from the feeling or dread of instant suffocation. It cannot now 
 lie down; and it either throws its head much in advance, as in 
 asthma, or bends its head very much backward ; or k finds no 
 relief but in a supine position, and that, apparently, the most 
 
 * We believe there cannot exist a doubt of the condition of the raucous mem- 
 brane of the trachea at this time — every thing would seem to declare it to be in 
 a state of active inflammation. The formation of a deciduous membrane, which 
 is sometimes thrown up, or after death proved by dissection to exist, and even 
 the remains of turgid vessels in this part, all announce inflammation of an active 
 kind to constitute the approximate cause of this disease. 
 
 The following is Laennec's " Anatomical Characters " of croup: " Croup is an 
 inflammation of the mucous membrane of the air passages, with exudation of 
 plastic pus, (coagulable lymph,) which becoming concrete at the very moment 
 of its formation, lines the (inner?) surface of the membrane to a greater or less 
 extent. When this false membrane is removed, the subjacent tunic is found of a 
 deep vivid red colour, occasionally livid, and somewhat thickened," p. -119. 
 
OF CROUP. 4()3 
 
 unfavourable to easy breathing. It is restless in the extreme, 
 and alternately ries every position, without finding relief from 
 any. 
 
 1558. The face is no longer flushed ; a dark lividity takes its 
 place, which sometimes spreads itself, even to the neck ; the 
 lips partake of this change, and the gums become pale and white, 
 while the tongse is not unfrequently blackish, as if the blood 
 were retained in it by a ligature. The forehead becomes shi- 
 ning, and the -skin looks as if it were tightly stretched over it 
 — it is wet with cold perspiration, as is now, indeed, almost 
 every part of the body. The pulse is small, frequent, fluttering, 
 and contracted. The heart beats with violence, nay, sometimes 
 audibly. The auxiliary muscles of respiration are now called 
 into requisition, and this proeess seems only maintained by 
 their aid ; a -deep hollow is made immediately below the xiphoid 
 cartilage, most probably by the severe contraction, or efforts of 
 the diaphragm; and the action of the heart is distinctly seen, 
 even at a distance from its seat. 
 
 1559. Though the cough is now more frequent, and the op- 
 pression much increased, the hoarseness is neither so great, nor 
 so sonorous. It is now almost a loss of voice, and the child, 
 when it speaks, seems to employ for this purpose a loud whis- 
 per. Even when it coughs, the voice is less harsh ; or rather 
 it has lost, in a degree, that appalling, brazen, vibratory sound, 
 with which the first two stages are attended. This change of 
 tone has but too often misled the inexperienced ear, to a belief 
 t£iat the disease was yielding; and thus has given rise to hopes, 
 that but too soon are for ever blasted. 
 
 1560. Thirst, oftentimes, becomes so intolerable, as to render 
 tke demands for drink both frequent and clamorous, though 
 every attempt to gratify be apparently.at the risk of suffocation. 
 The countenance is now anxious beyond expression ; the eyes . 
 become most piercingly brilliant and beseeching — they elo- 
 quently implore a relief, which neither affection nor science 
 can afford ; and the poor sufferer expires, with a look full of 
 supplication and anguish.* 
 
 * We have sometimes seen, a short time before death, the little patient lie on 
 its back, apparently resigning* itself to a fate against which it could no longer 
 struggle, and eventually expire, and that with a complacency, that would create 
 a hope, that its sufferings had terminated even before death had relieved them. 
 
464 
 
 OF CROUP. 
 
 1561. This disease runs it's course variously; sometimes it 
 lingers for days, while, at others, its career is finished in a few 
 hours. This variety in termination will depend upon the con- 
 stitution ; upon the period at which remedies were applied; 
 upon the nature of the remedies, and their power or influence 
 upon the system. 
 
 1562. Dissection proves that this disease, in many instances, 
 kills-by suffocation, from a mechanical cause; at other times, no 
 such obstruction can be found — therefore, pathologists declare 
 spasm to be the cause, where the mechanical one is not present. 
 This, by some, has been extended even to the formation of 
 a distinct species of croup ; namely, the spasmodic; a kind we 
 have never witnessed. By others, this has been modified, and 
 the pathology of croup made to consist in inflammation and 
 spasm united. We do not believe in the presence of spasm, in 
 either of the first two stages of this complaint; it may take 
 place, and probably does, sometimes in the last " Dr. Marcus, 
 of Bamberg, in Bavaria, looks upon all fevers as inflammation of 
 some one organ or other, and as entirely seated in the arterial 
 system, regards croup as a local inflammation alone, utterly in- 
 dependent of spasm, which neither exists here, nor in fevers of 
 any kind."* 
 
 1563. Some have disputed the formation of a membrane with- 
 in t"he trachea ; but it can only be by those who are not in the 
 habit of investigating diseases by dissection — we have seen it, 
 more than once, and, of course, we are convinced of its exis- 
 tence. Others, who will not venture to deny the presence of a 
 foreign body within the trachea, deny it to be a membrane; — 
 they declare it to be nothing but inspissated mucus, and not a 
 membranous product. At this day, there can be nothing new 
 in the declaration, that if lymph be poured out from vessels in 
 a certain state of action, upon either exposed surfaces or within 
 cavities, that it will form membrane: the pleura and the perito- 
 neum furnish almost daily examples of this kind.f This mem- 
 
 * Good's Study of Medicine, Am. Ed. Vol. 2d, p. 235. 
 
 f When this substance is chemically examined, " the secretion appears to con- 
 sist chiefly, if not entirely, of the gluten, or coagulable lymph of the blood, di- 
 luted with its serosity, and copiously combined with that peculiar substance of 
 the blood, which has received the name of fibrin." — Good's Study of Medicine, 
 JLm.ed. Vol. 2d, p. 234. Guibert says it consists of albumen. 
 
 "It is a little singular that children should be chiefly subject to its attack, at 
 
 
OF CROUP. 465 
 
 brane extends from below the larynx to the bronchial ramifica- 
 tions; and we once saw it within them. 
 
 1564. Laennec, p. 120, says, " The false membrane of croup 
 corresponds exactly with the form of the canals which it covers. 
 Its thickness is usually somewhat greater in the larynx and tra- 
 chea than in the bronchia, and varies from less than half a line 
 to a line. Its consistence is that of boiled white of egg, but this 
 usually diminishes towards its extremities, so that it becomes 
 sometimes, in this situation, scarcely more solid than the thick 
 phlegm of catarrh. It is of a white colour, with sometimes a 
 shade of yellow, and is almost entirely opaque." 
 
 1565. From what has been said, it will be evident, that no- 
 thing but the use of very efficient remedies can arrest the pro- 
 gress of this disease; and for them to be availing, they must be 
 employed sufficiently early, to prevent the inflamed lining of 
 the trachea from relieving itself by effusion. For when this • 
 happens, the case, for the most part, is hopeless; though some 
 few instances have occurred, where recovery took place after its 
 formation — but their rarity only shows the little we have to hope 
 at this stage, and the importance of early attention to this disease. 
 
 1566. It is now so generally admitted, that this is a local dis- 
 ease, and one consisting in an active inflammation of a highly 
 important part, that there is scarcely any dispute as to the ge- 
 neral mode of treating it, though there may be some variety in 
 the detail, and the agents intended to fulfil the same obvious in- 
 dications. Therefore, with a view to the better illustrating the 
 particular mode of treatment, we shall follow the stages we have 
 made this disease to consist of, and shall begin w T ith the mode of 
 treating the 
 
 i 
 First Stage. 
 
 1567. If due attention were paid to the timely application of 
 appropriate remedies in the forming stage of croup, we have 
 every reason to believe, that this complaint could be stopped in 
 limine, in nineteen cases out of twenty. It is to the ignorance 
 of what a hoarseness may lead, that this obvious, and almost 
 certain symptom, when it first manifests itself, is neglected; and 
 
 whose age fibrin is not peculiarly abundant, and whose blood contains compara- 
 tively but a small portion of azote, which in fibrin is so large a constituent." — ■ 
 Ibid. 
 
 50 
 
466 OF CROUP. 
 
 to this neglect must be attributed, the too often fatal termina- 
 tion of croup. 
 
 1568. A sufficient experience justifies the declaration just 
 made ; and the same experience will, we trust, screen us from the 
 imputation of becoming alarmists, when we declare that no 
 hoarseness in children can be neglected, but at the risk of life. 
 We can call to mind but too many instances of fatal issue, where 
 this friendly warning was unheeded, because its tendency was 
 not understood. Our anxiety to abridge the ravages of this ter- 
 rible disease, has led us to dwell upon this point longer than 
 would be necessary for the mere medical reader; but we hope 
 he will excuse us for our cautions, which, though not necessary 
 to him, may be very important to others, who may honour this 
 work with a perusal. 
 
 1589. It has been our misfortune to have witnessed but too 
 much of this disease; and, unhappily, too much in our own im- 
 mediate family. We were early instructed in all its phenomena; 
 and but too sorely taught its deadly tendency. Our misfortunes 
 made us more than vigilant — made us tremblingly apprehensive 
 to every thing connected with this disease, especially its forma- 
 tion.* But, perhaps, we have derived advantage from pur losses ; 
 
 * The ear of one who has lost a child with this complaint, becomes so extreme- 
 ly sensitive, that it instantly gives the alarm as soon as a hoarseness is perceived: 
 and sometimes leads to an interference, that would, perhaps, not be justified upon 
 any other occasion. To illustrate this, and to show how the feelings may be im- 
 pelled, under such circumstances, we will relate an anecdote which befell ourselves. 
 Passing 1 a house, towards evening, in one of our streets, our ears were assailed by 
 a hoarse cough, which proceeded from a shivering little boy of about three years 
 old, who was at the door, but which was shut against him. 
 
 He appeared very cold: it was a drizzly evening, and the month was November. 
 At this time, our loss of an only child with croup, was recent; and we were labour- ( 
 ing under all the wretchedness such a loss could inflict, and of course were pecu- 
 liarly sensitive to every thing which reminded us of a disease, which had created 
 for us so much misery. We knocked at the door, and begged to see the mother 
 of the child: the person before us proved to be the one we wished to see. We 
 represented to her the dangerous situation her little boy appeared to be in, and 
 begged she would immediately send for her family physician, to visit the child, 
 advising, at the same time, what we judged proper to be done, until he should 
 arrive. The mother laughed at our fears; and said it was nothing but a little cold 
 the child had taken, and declared he would be well enough in a day or two, 
 " without any doctor stuff." 
 
 We took our leave; but feeling interested for the child, we went nest day to 
 inquire for him; and was told by a next door neighbour, that he had died early 
 that morning of " hives:" — our feelings can be better imagined than described. 
 
of croup. 467 
 
 and mosl happy shall we be, if they can be made subservient to 
 the general good. 
 
 1570. For many years, nothing could exceed our horror, 
 when called to attend a case of croup — for our too faithful ears 
 could not forget the appalling sound of the breathing; alas! they 
 were instructed by instances of such endearment, that memory 
 was almost a curse. 
 
 1571. We were thus forced to a knowledge of the rise, pro- 
 gress, and issue of croup — would we could add, we were equally 
 well instructed in its management — to this, however, we make 
 no particular pretensions; though we think we have arrived at 
 some certainty in arresting its march. Our particular horror of 
 croupy hoarseness, led us necessarily, after a time, to the very 
 early application of remedies for its removal — hence, for the 
 last twenty years, we have never suffered it in our own family, 
 to exist a single hour, without an attempt to stop it. 
 
 1572. As this disease most commonly attacks in the night, 
 (1542) we have ever at hand, the remedies about to be men- 
 tioned, that not a moment may be lost in their application. It 
 is, therefore, our constant habit, the instant we observe the 
 croupy sound, to inflame the external throat by the application 
 of the spirit of turpentine, hartshorn, or mustard and vinegar. 
 This we repeat, if. the first have not subdued the hoarseness, as 
 soon as the rubefacient effect has subsided; for it may be pro- 
 per to observe, we do not carry the stimulation to blistering. In 
 aid of those external applications, we administer in doses suitable 
 to the age of the child, "the compound sirup of squills," or 
 Coxe's hivesirup,as an expectorant, or, if necessary, asan emetic. 
 
 1573. If the hoarseness do not yield to the turpentine, or to 
 expectorant doses ef the sirup, we urge the latter, by quickly 
 repeating the dose, to an emetic effect; but this is rarely neces- 
 sary, if the complaint have been taken early, or if the throat 
 have been well inflamed. For we can most truly declare, we 
 have very often seen this disease subdued in an hour or two. 
 But should the hoarseness not disappear, though much dimin- 
 ished, we continue the use of the sirup, until it do. Should the 
 bowels be confined, we give a dose of castor oil, in aid of the 
 general intention. 
 
 1574. With the same intention, we regulate the diet — or ra- 
 ther make it consist of barley water, or flax-seed tea ; we confine 
 
468 op croup. 
 
 the patient to an atmosphere of moderate temperature, and most 
 sedulously guard him against exposure, or a draught of air, 
 The throat must be protected by a piece of flannel, or some 
 other warm covering, after the turpentine or mustard has been 
 removed. 
 
 1575. It is truly astonishing, with what certainty this plan 
 arrests this disease, in by far the greater number of cases. An 
 experience of very many instances, fully justifies our commen- 
 dation of it. We, therefore, earnestly advise every mother, 
 and especially those who may have children subject to this 
 complaint, to have immediately at command the articles just 
 mentioned, and to employ them, as just directed, the instant 
 hoarseness may appear. If this be faithfully attended to, we 
 shall rarely have an opportunity to prescribe for 
 
 The Second Stage. - 
 
 1576. It may, however, happen, that the plan just suggested 
 may not be availing; that the proper time for their application 
 has been lost; or, that we have not seen the patient, until the 
 second stage has been completely formed; in either of these 
 events, we are obliged to prescribe for the case as it presents 
 itself. We shall find the system in the second stage (1556) in 
 one of two conditions: namely, 1st, where the disease is com- 
 pletely formed as regards the state of the trachea; but without 
 the arterial system being much affected: or, 2dly, where the ac- 
 tion of the arterial system is much exalted, in consequence of 
 the inflammation of the trachea. These two conditions, in our 
 opinion, require some difference in the mode of treatment; and, 
 first, of that condition, where the .blood vessels, of the system 
 at large, are not much affected. 
 
 1577. In this case, the force of the disease is mainly spent 
 upon the organs immediately concerned in respiration; hence, 
 the cough is more frequent, nay, sometimes almost incessant; 
 the hoarseness less deep, but more sonorous, ^and vibrating; no 
 expectoration, or in a very trifling degree, and that of uncon- 
 cocted serum, the discharge of which affords no relief. The 
 face, for the most part, rather pale, or partially flushed; the nos- 
 trils very dry ; the hands and skin generally rather below the 
 natural standard; the eyes somewhat blood-shotten ; the pulse 
 
op croup. 469 
 
 frequent, and small, and the respiration laborious, and every 
 hour becoming more and more so. 
 
 1578. In this situation, we have thought, the remedy so ex- 
 clusively relied upon by many, namely, blood-letting, always 
 injurious, or certainly never beneficial — we, therefore, can- 
 not, agreeably to our present impressions, recommend it; since, 
 under such circumstances, Ave never now employ it, either ge- 
 nerally or topically. We always commence the treatment, by 
 the stimulating applications (1572) to the throat; and quickly 
 administer a brisk emetic of the tartrite of antjmony; or, should 
 it be immediately desirable to procure evacuations from the bow- 
 els, we combine with it, liberal doses of calomel, according to the 
 following formula, for a child of two years old, or rather more. 
 
 E. Tartrite of antimony gr. ij- 
 Calomel prepared gr. xij. 
 
 These to be intimately mixed, and divided into eight parts — one 
 of these to be given every twenty minutes, or half hour, mixed in 
 a little thin sirup, until an emetic and cathartic effect be produced. 
 Should it prove pretty powerfully emetic, we make the intervals 
 longer; that is, once in an hour, and more seldom in proportion 
 to the effect, until the bowels be freely moved, or even purged. 
 
 1579. After the medicine has operated" freely, w T e order the 
 hive sirup in suitable doses, (1572) every half hour, or hour, or 
 more seldom, as the effect may be more or less ample. Should 
 the disease not have yielded to this discipline, we give calomel 
 in pretty large quantities, every two hours, as long as the bow- 
 els will bear it without being too much purged; always recol- 
 lecting, that the expectorant doses of the hive sirup are not to be 
 discontinued, unless there be much nausea. 
 
 15S0. If the above remedies make a suitable impression 
 upon the disease, an abatement of all the unpleasant symptoms 
 will take place, and give us some assurance of a favourable issue. 
 In the condition of the system now under consideration, we must 
 not neglect to observe, that we reckon among the favourable signs, 
 a greater warmth of skin, with a slight disposition to perspira- 
 tion, and an increase of force, and vigour in the circulating sys- 
 tem; for when these take place, there is less risk of its running 
 on to the congestive stage, or at least this period is delayed. Be- 
 sides, this change is an evidence of the disease being now less 
 
470 op croup. 
 
 concentrated, and that the system can now bear farther depletion, 
 with advantage, should it be judged necessary. This is so de- 
 cidedly the case sometimes, that we can with much profit to our 
 patient, abstract blood, either from the system generally, or from 
 near the parts, by cupping. In a word, the disease is now con- 
 verted into the second condition; or where the arterial action is 
 much exalted. « 
 
 1581. In this second stage of the disease, the symptoms are 
 rarely so appalling as in the first, though of the same general 
 character. The disease is less masked, and we, consequently, 
 have a more open enemy to deal with. In this condition, we 
 almost exclusively rely upon blood-letting to make a first, and 
 favourable impression; and there are few, who have not witnessed 
 with what promptitude and success this is sometimes effected. 
 The bleeding, to be successful, must be carried to a sufficient ex- 
 tent; that is, until it make a decided impression upon the pulse; 
 or until it flutter under the finger, or a disposition to syncope dis- 
 cover itself. 
 
 1582. Some have advised that the blood should be drawn from 
 the jugular vein; there may be an advantage in this, that our 
 present experience does not recognise: certain it is, we should 
 not hesitate to select this part, were we left entirely to ourselves, 
 since its nearness to the diseased parts would lead to the belief 
 that they might more certainly and speedily be relieved by it. 
 But to make choice of this vein as a general rule to bleed from, 
 we should have to contend with much prejudice ; more, perhaps, 
 than the selection is really worth — but at the same time, we 
 would recommend, that this part should not be lost sight of, in 
 certain ferocious cases, where life may depend upon the diffe- 
 rence of influence that the bleeding from one part, rather than 
 from another, may produce.* 
 
 * A late writer, Mr. Goodlad, (North of England Med. and Surg. Jour. No. 2) 
 says, " From what has already been said, it is evident that two indications are ne- 
 cessary to be attended to, in the cure of croup; the first is to subdue the inflam- 
 mation of the windpipe, the other to relieve the oppressed circulation. Unless 
 the first object be attained, no means will avail; nor will it in every case be safe 
 to wait until that can be accomplished, before we relieve the system at large. 
 Danger may be imminent from either of these causes, and we have often to de- 
 termine whence it is most so, and to regulate our practice accordingly. 
 
 " The causes which produce croup, its symptoms and progress, alike indicate 
 the necessity of blood-letting, and this remedy, in comparison with which all 
 
OS* CROUP* 471 
 
 1583. The repetition of the bleeding must be governed by 
 circumstances ; for bleed we must, in some cases, again and again, 
 if the system react with force, and the pulse be found of diffi- 
 
 others sink into insignificance, should be immediately resorted to. Any quantity 
 of blood may be drawn by leeches, and the local complaint, in almost all cases, be 
 subdued by them; for if one crop of leeches do not remove it, others must follow, 
 until the breathing- become free, or the child so faint that farther depletion would 
 be unsafe. This mode of taking* blood, by emptying* the vessels, which are in- 
 flamed, will, it is evident, afford relief, with least expense to the constitution; but 
 when the complaint has existed many hours, and ,the jug*ular vein becomes alter- 
 nately distended and collapsed, during* each inspiration; when the angles of the 
 mouth are drawn downwards, every muscle of the neck brought into action, and 
 the breathing consists of a series of gaspings, there will not be time afforded for 
 leeches, and not a moment must be lost. The external jugular vein should be 
 immediately opened with the lancet, though this operation is sometimes exceed- 
 ingly difficult, requiring a quick eye and a steady hand to catch it between each 
 inspiration. The struggles of the patient, and the great contraction of the mus- 
 cles, add to the difficulty; but no consideration should deter us from giving instant 
 relief, and no other method of taking blood seems to afford the same immediate 
 benefit both to the head and breathing. The child may be on the brink of effu- 
 sion, and every minute lost is matter of serious reproach; but this urgency of the 
 case, which, if not attended to, will speedily be followed by stupor, and that loss 
 of sensibility over the whole frame, so favourable to effusion, renders additional 
 precaution necessary; for if the depletion be carried too far, or the vessels emptied 
 very suddenly, that event, so much to be dreaded, will be accelerated. 
 
 " The finger should therefore be kept upon the pulse while the blood is flow- 
 ing, and the farther flow of blood prevented, if the breathing* be properly re- 
 lieved, before faintness is induced. It is safer to trust the farther treatment of the 
 case to leeches, which are, indeed, often necessary even when the jugular vein 
 has been opened, and the loss of blood carried for the time to the greatest ex- 
 tent. This will not be matter of surprise, when we consider how little connexion? 
 there is between the arteries ramified upon the inner surface of the windpipe, 
 and the external jugular vein. It is safest, therefore, to unload the general cir- 
 culation, where that is 'requisite, from the system at large; and treat the local com- 
 plaints with leeches, where they can be easily obtained; but if not, the finger may 
 be placed upon the orifice for a short time, when the breathing is relieved; and 
 another and a smaller quantity of blood be taken from the same orifice, until 
 faintness deter us from proceeding farther. 
 
 "I have generally directed leeches to be put on the lower part of the wind- 
 pipe, below the pomum Jldami, because they bleed quite as well as on the upper 
 part of the tube. The blood is drawn from those vessels, which have most re- 
 cently taken on the diseased action; the inflammation is thereby prevented from 
 extending, and the vessels, already weakened by disease, are emptied more gra-^ 
 dually, and with less danger of their giving way. 
 
 " In whatever manner the blood be taken, a degree of faintness must be pro- 
 duced, and kept up for some time, which renders the continuance of inflamma- 
 
472 of croup. 
 
 cult reduction. But here we would wish to caution the inexpe- 
 rienced practitioner, against making the difficulty of breathing 
 the only indication for more blood-letting; this should constitute 
 but one of the considerations ; for, of itself, it is not always suf- 
 ficient ; especially in a rapid case, or in one, in which the first 
 stage of the disease was altogether neglected, and the commence- 
 ment of the second but feebly treated. 
 
 1584. To make a second bleeding proper, there must be a 
 continuation of the same symptoms, though, perhaps, with a less 
 degree of force, which made us determine upon this operation 
 in the first instance ; that is, the pulse must be firm, the skin 
 warm, the face flushed, and the oppression considerable. 
 
 1585. If these conditions obtain, we should not hesitate a mo- 
 ment to draw more blood ; and that to an extent that shall pro- 
 duce an evident alteration in the force of the pulse : but two 
 bleedings are notto follow each other, without the interval being 
 employed in the exhibition of other remedies ; and among the 
 first of these, are, the emetics and the expectorants, as has been 
 already advised, (1572 and 1578) together with the use of calo- 
 mel. In this state of the disease, as in the one just considered, 
 the emetic should be followed by the hive sirup, so as to main- 
 tain a nauseating influence, as well as occasionally to provoke 
 the stomach to vomiting. 
 
 1586. The rubefacient remedies should now succeed the ope- 
 ration of the emetic ; and such a quantity of oalomel should be 
 administered, either with the tartrite of antimony, or alone, as 
 
 tion impossible, and the patient watched most narrowly, lest reaction come on, 
 and more leeches be necessary." 
 
 We have made this long extract, to show fairly this gentleman's pathological 
 and therapeutical views of this disease; not, however, with the intention of re- 
 commending the practice, for we still maintain our views unimpaired as to the 
 mode of treatment — for in our hands, at least, leeching has been decidedly hurt- 
 ful. If faintness be desirable, we would very much prefer Dr. Chapman's plan- 
 that is, abstracting blood from the arm until a disposition to syncope be perceived. 
 Or, indeed, this gentleman's suggestion, (though not original with him,) of open- 
 ing the jugular vein; but not at the moment he indicates — for it is then, we fear, 
 too late, as the symptoms he details mark the stage of effusion; or, at least, that 
 stage of inflammation, at which it is about to take place; a period, if our obser- 
 vations be correct, that effusion is but hastened by bleeding. We could say much 
 upon the whole of Mr. G's. text quoted; but we did not see his observations, 
 until this chapter was almost in type. 
 
of croup. 473 
 
 already suggested, (1578,) as to procure a free discharge from 
 the bowels. 
 
 1587. The greater the disposition the disease has to run a ra- 
 pid course, or, in other words, the more sudden and violent the 
 attack, the greater, as a general rule, will be the chance of suc- 
 cess from the use of proper remedies, and especially that of 
 blood-letting; for it almost always happens, that the slower cases 
 are attended by an indolent inflammation, or an engorgement, 
 that will not so well bear the loss of blood, or will certainly profit 
 less by it. 
 
 15S8. When the practitioner may be reluctant to draw more 
 blood from the general system, and yet believes the inflamma- 
 tion cannot be subdued without farther depletion, he generally 
 has recourse to local bleeding — hence the frequency of leeching 
 and cupping in croup. 
 
 1589. This practice is recommended by almost every practi- 
 tioner; and, by some, of very high authority; it may, therefore, 
 not only excite surprise, but, perhaps, draw upon us reprehen- 
 sion, when we enter our protest against it; and especially against 
 leeching. (See note to par. 1582.) 
 
 1590. We are free to admit, it appears every w T ay plausible, 
 that drawing blood from near the inflamed part, should be at- 
 tended with more success, than when it is taken from a part 
 more remote : yet, in the particular instance we are considering, 
 our experience gives a uniform contradiction to the hope of be- 
 nefit from the practice; though it does not impair the truth of 
 the general position. But this failure of benefit from local bleed- 
 ing in the case under consideration, must not be considered, 
 however, even as an exception to the general rule just mentioned, 
 but as depending in a great measure, or, perhaps, altogether, on 
 circumstances inseparable from the operation of leeching itself, 
 The operation of leeching is attended with several circumstances 
 decidedly averse to this disease: for, 1. It employs considerable, 
 time; during which the patient is obliged to maintain an irksome 
 position, and this may be extremely unfavourable to his breathing. 
 2. It often becomes important that the quantity of blood to be 
 drawn should be very exactly determined ; this cannot be done • 
 in leeching — especially as the after bleeding is sometimes very 
 considerable, in spite of every attempt to arrest it, to the ma- 
 nifest injury of the patient. 3. Their coldness, and the sudden 
 
 GO 
 
474 op croup. 
 
 exposure of the throat, after having been warmly covered, is 
 oftentimes so mischievous, that the bad symptoms can be seen to 
 increase during the operation ; and are almost sure to follow im- 
 mediately after. We can most safely declare we never have in 
 a single instance seen it do good; but we have, in a number of 
 Cases, seen it do harm. 
 
 1591. If topical bleeding be had recourse to, let it be by cups: 
 against these, the objections are not so strong. And, when em- 
 ployed, let it be from between the shoulders, or rather from the 
 back of the neck : when drawn from this place, we have seen it 
 useful. Gups should never be applied over the throat, for rea- 
 sons sufficiently obvious. 
 
 1592. Dr. Cheyne says, " When bleeding is used upon the 
 commencement of the violent symptoms, the relief is often im- 
 mediate ; and I have scarcely believed that I saw the same child 
 breathing softly, who, ten minutes before, lay gasping and con- 
 vulsed," (p. 17.) We have never had the good fortune to see 
 this sudden good effect from bleeding in a case of genuine croup; 
 we have a number of times witnessed very prompt relief from 
 this remedy, in the spurious, or that kind which is accompanied 
 with sore throat, (1548.) For the vessels of the fauces seem to 
 feel the influence of venesection, more certainly and speedily, 
 than those of the mucous membrane of the trachea. 
 
 1593. Neither in the stage of the disease now under conside- 
 ration, nor in either of the other two, have we ever witnessed any 
 advantage from severe purging; though there is evident use in 
 having the bowels freely opened. Indeed, in the congestive stage, 
 we think we have constantly found it injurious; for it rapidly 
 diminishes the strength, without weakening the disease at the 
 same time. For it would seem there is less intercommunion be- 
 tween the bowels, and the respiratory viscera, than with almost 
 any other parts of the body. 
 
 1594. Puking in this stage, (the second,) is manifestly useful, 
 especially when considerable nausea accompanies the operation: 
 it must, therefore, be repeated as often as the 'breathing seems 
 to be obstructed by accumulating phlegm. We believe the tar- 
 trite of antimony to be the best emetic, in this stage of the dis- 
 ease. The sulphate of copper has been highly extolled lately; 
 in our hands, it has failed. 
 
 1595. Blisters are highly recommended by some: as regards 
 
of croup. 475 
 
 our own experience, we are by no means convinced of their uti- 
 lity, unless it may be in the forming state of this complaint, and 
 at the termination of the second ; but even then, we are not in 
 the habit of relying on them. We prefer the rubefacients, (1572) 
 as their powers are more at command, and can be renewed when- 
 ever they have ceased to maintain a proper degree of irritation. 
 It has appeared to us, there is a period of the disease, in which 
 blisters may be useful ; but are not exclusively to be relied on, 
 as just stated: we have occasionally employed them at this time, 
 and once or tw r ice with marked advantage. It is, when the se- 
 cond stage is merging into the third. At this time, in some few- 
 instances, they seem to act with peculiar felicity. 
 
 1596. "The warm bath is a very unequivocal remedy; but as 
 it is a simple and popular one, it is generally used along with an 
 emetic, before the physician is called; and together or separately, 
 by their antiphlogistic powers, they in very many instances pre- 
 vent the formation of the disease." (Cheyne, p. 25.) 
 
 1597. There are few remedies in this disease so popular, or 
 so much abused, as the warm bath — it is one, we feel more diffi- 
 culty in prescribing, than any other of the materia medica; for it 
 seems to us to be more uncertain, and varied in its effects, than 
 any other. Nor is this to be wondered at; since, the tempera- 
 ture is never exactly fixed, and each given temperature must be 
 a new remedy; or, at least, a remedy with a different power. 
 Again; the state of the nervous, and arterial systems,. must be 
 constantly varying; therefore, the effects of this remedy must 
 necessarily be governed in a degree by these conditions. The 
 state of the cutaneous system, must also vary as to susceptibility; 
 therefore, temperature must have different operations upon it; 
 these differences must, of course, lead to very different results; 
 and this, we have so uniformly found to be the case, that we 
 never prescribe this remedy, but with all the uncertainty which 
 must necessarily attend applications empirically made. 
 
 1598. Nor can we agree with Dr. Cheyne, in calling the 
 warm bath a " simple remedy," if he mean that it is one with- 
 out any decided powers; we look upon it as one of extensive in- 
 fluence; and may, therefore, be most easily abused, if not judi- 
 ciously directed ; as it has, unfortunately, become a domestic re- 
 medy. Besides, let us call to mind the importance of the sur- 
 face on which this remedy is to act; either as regards its own 
 
476 of croup. 
 
 functions, or the functions of parts which so powerfully sympa- 
 thize with it; and we shall find there is no good ground to con- 
 sider this remedy as a " simple" one; at least, not agreeably to 
 our definition of a simple remedy. 
 
 1599. This, of all the remedies employed in croup, requires 
 the most judgment in prescribing it, and certainly, the greatest 
 caution, to apply it properly. We have never seen it managed 
 with so much address, as not to have made us tremble for the 
 Consequences; nor with so much success, as to tempt us to brave 
 them. We can most conscientiously declare, we have never in a 
 single instance witnessed any decided advantage to arise from its 
 application ; but we can most truly say, we have had the most 
 unequivocal evidence of injury. We, therefore, never prescribe 
 it in this disease. In this, We are aware, that we differ from 
 much authority, and especially Guibert, who has written upon 
 croup with much good sense and practical acumen: of the warm 
 bath he is even extravagant (as we think) in its praise. He says, 
 " A very rational means of the cure of croup consists in frequent 
 and reiterated employment of warm baths ; of which experience 
 has taught me the good effects." But until subsequent experi- 
 ence shall lead us to a contrary belief, we shall continue to bear 
 testimony against it. We shall take the liberty of joining Mr. 
 Goodlad's observations upon this remedy, as they serve to 
 strengthen what we have just advanced. u Among these," he 
 adds, " the warm bath is one of the most active and at the same 
 time the most injurious; and I cannot imagine how any one, who 
 has once witnessed its effects, can again recommend it in croup. 
 It is, in my opinion, so decidedly hurtful, by quickening the cir- 
 culation, that I should interdict its use in almost all inflammato- 
 ry cases. The Warm bath, I think, is never useless, unless pro- 
 longed until faintness be produced; and in the early stages of in- 
 flammatory complaints, it is often impossible to produce this ef- 
 fect, until the heart beats more than 130 times in a minute, 
 which is a degree of excitement I think unwarrantable. If re- 
 sorted to later, effusion is brought on sooner than it would other- 
 wise supervene; and many practitioners could, I think, call to 
 mind cases, where its use has been followed by unexpected death: 
 the vessels previously emptied, perhaps, by bleeding, having 
 given way, and apoplexy supervened." 
 
 1600. Bo not let us be understood to condemn this remedy, 
 
of croup. 477 
 
 when employed by others, because we do not ourselves under- 
 stand its management; we only mean to confess our ignorance 
 of the proper state, or time, for its application. We are afraid 
 that this remedy has become too much a part of routine in this 
 complaint; therefore, very likely to be abused. There is a po- 
 pular feeling in its favour, which we are very certain it does not 
 deserve; and in consequence, it becomes "a domestic remedy," 
 and " is employed before the physician sees the patient," and 
 that, we fear, to the injury of the individual who is subjected 
 to it. 
 
 1601. Laudanum, in combination with antimony, is recom- 
 mended by Dr. Cheyne, when the febrile symptoms run high — 
 we admit this to be high authority for the practice; but unless 
 we witness more success from this combination in the hands of 
 others, than has been experienced by ourselves, we shall not 
 again be tempted to employ it. Laudanum, as far as our expe- 
 rience goes, has ever been injurious in this stage. 
 
 1602. If the disease do not yield pretty early after the for- 
 mation of the second stage, to the remedies just pointed out, the 
 vessels of the inflamed surface relieve themselves by effusion, 
 and thus form 
 
 Tlie Third Stage. 
 
 1603. This stage consists in the formation of a deciduous mem- 
 brane, (1587, &c.) which more or less, strictly fills the trachea, 
 or else, in the pouring out of a quantity of purulent lymph, which 
 does not coagulate; but almost as certainly obstructs the air pas- 
 sages. This effusion is not confined, however, in all instances, to 
 the trachea; the bronchial vessels relieve themselves, in the same 
 manner; and this, sometimes, throughout the lungs; as far, at 
 least, as the naked eye can trace them. 
 
 1604. It is of much importance to recollect this highly im- 
 portant pathological truth ; since it will have a strong bearing on 
 the question of an operation, whenever this may be agitated. 
 
 1605. The third stage (1557) is necessarily one of great hope- 
 lessness; since we cannot, with certainty, get rid of the existing 
 obstruction; or, if we could, we cannot alter, or, at least, but 
 very rarely, the disposition of the parts, to perpetuate the diffi- 
 culty by the formation of new productions. 
 
 1606. The indications in this stage, are, 1st, to remove the 
 
478 of croup. 
 
 obstructing lymph from the windpipe; and, 2dly, to prevent the 
 formation of more, by altering the condition of the inflamed sur- 
 face of the trachea. 
 
 1607. In some few instances, emetics have fulfilled both the 
 one and the other indication; and the patient has been thus most 
 unexpectedly snatched from the grave.* The membrane has 
 been more frequently removed from the trachea, than its removal 
 has been attended by success to the patient, after its discharge. 
 
 This is a most melancholy truth, and one that should not be 
 lost sight of; especially as, on the removal of the membrane, re- 
 covery is so confidently expected. Never shall we forget our 
 feelings when this took place in a beloved child of our own ; nor 
 ever cease to remember our disappointment, when we found it 
 to be unavailing. 
 
 1608. Michael is, (Cheyne, case x. p. 65,) relates a case of 
 death after the membrane was twice discharged by emetics; nor 
 is this surprising, since, by the removal of the obstruction, we 
 do not remove the disposition to subsequent effusion; and as long 
 as this continues, there can be no security against new forma- 
 tions. 
 
 1609. But this is not to make us abandon an enterprise in 
 which so much may be gained, if we succeed in removing the ob- 
 structing membrane; especially as the same author furnishes us 
 with an instance of success, after the membrane had been 
 thrown up. 
 
 1616. As in the*third stage, the obstruction is purely mecha- 
 nical, so far as we know ; and as that consists of a membranous 
 production, but feebly attached to the side of the trachea, (1562,) 
 as fresh lymph is, most probably, constantly pouring out, to weak- 
 en its adhesion, it would seem that that remedy which would give 
 the most sudden shock to the respiratory organs, would give the 
 fairest chance to remove it — hence, the utility of pretty power- 
 ful emetics at this period. 
 
 1611. In this, all practitioners seem to agree; but there is 
 
 * "I shall here notice those (remedies) only, which have been found decided- 
 ly beneficial. Of this kind are emetics, repeated daily, or even twice a day. 
 They evidently accelerate the separation of the adventitious membrane, and fa- 
 vour its expulsion. However valuable this treatment may be, and I have myself 
 obtained cures which I could attribute to it alone, it is no doubt too true that the 
 greater number of cases still prove fatal."— Laennec, p. 126. 
 
op croup. 479 
 
 some variety of opinion, on the proper substance for this pur- 
 pose. In Europe, saline, or antimonial emetics are considered 
 best; in this country the polygala seneca in very strong decoc- 
 tion is preferred ; and, we believe, with propriety. At least, 
 the dnly instance we have witnessed of the expulsion of the 
 membrane, was produced by a very strong decoction of this root.* 
 We would, therefore, rely on it with more confidence than any 
 other of the emetic substances. 
 
 1612. This medicine is, however, apt to run off by the bowels 
 when exhibited thus strong; should this be the case, a quantity 
 of laudanum sufficient merely to restrain its purgative effects, 
 should be given from time to time. Two or three drops every 
 two or three hours, will generally be found sufficient for this 
 purpose. 
 
 1613. We have but very little confidence in any other reme- 
 dies in this stage of the disease; especially any that can fulfil 
 the second indication, unless emetics do. The sulphate of cop- 
 per has been much praised in this disease, and is by some sup- 
 posed to possess much advantage over the antimonial prepara- 
 tions; but in this commendation, our own experience will not 
 justify a preference: we have employed it several times, and 
 under circumstances we deemed fair for its use, but without any 
 advantage that we have not seen produced by the tartrite of 
 antimony. We have never seen calomel, blisters, or warm bath, 
 do the least good at this period: indeed, the painful remedies 
 should now, we think, be withheld, (if we except the more 
 powerful rubefacients,) since they hold out so little promise of 
 success. We thought we saw evident relief in a late case, from 
 the spirit of turpentine.t Twenty drops were given every 
 hour: it seemed to relieve much, but the patient died. 
 
 * Take half an ounce of powdered seneca, pour on it half a pint of boiling- 
 water, and let it simmer until nearly half reduced? strain it carefully, and give a 
 tea-spoonful every fifteen or twenty minutes, until it puke. This quantity will 
 answer for a child from one to three years old — for one of greater age, two tea- 
 spoonsful at a time maybe given; but, we believe, the decoction should never b 
 weaker than the above. 
 
 f.What might be the effects of this medicine, if boldly pushed, in the con- 
 gestive stage of croup, we have yet to learn; we think, however, it deserves 
 a trial, as its influence upon the mucous membrane seems to be undisputed. We 
 shall certainly urge it the 6rst fair opportunity we have the misfortune to con- 
 tend with, 
 
480 OP CROUP. 
 
 1614. As a last resource, tracheotomy has been proposed with 
 confidence : but it has been but too often performed without 
 success. Nor is this to surprise us; since by the operation no- 
 thing more can be expected, than has resulted from the sponta- 
 neous discharge of the membrane; and we have already said, 
 (1607) that this is but rarely followed by permanent relief. 
 
 1615. In our opinion, the operation has been proposed with 
 more intrepidity than discretion; for until we can prevent new 
 accumulations after the removal of the previous ones, we need 
 promise ourselves but little success from this scheme. It has 
 been said, that the failure from this operation has been princi- 
 pally owing to its being performed too late, and hence it has 
 been advised early in the disease. But who would promise 
 himself, that he had saved life by this operation, should the pa- 
 tient even live, since if it be performed early, other remedies 
 might have succeeded as well? And when performed late, who 
 has witnessed its success? Therefore, in the early stage of the 
 disease, the operation is certainly not called for, nor would it 
 be proper to have recourse to it, since the disease is very often 
 relieved without it; and in the latter, we believe it has ever 
 been unavailing. 
 
 1616. We have seen it performed twice without success, 
 where the operation, simply considered, had every advantage 
 which sound judgment, and consummate skill could give it — ■ 
 for Dr. Physick was the operator. And we believe we do not 
 venture too much when we say, he has no confidence in it. Dr. 
 Cheyne employs some most convincing arguments against this 
 operation; to which, we with much pleasure refer those who 
 may wish to investigate this subject farther. 
 
 1617. But notwithstanding the unmanageable character of 
 this disease, when its first stages have been neglected, or freely 
 treated, we have the experience of some -of the most respecta- 
 ble practitioners, as well as our own, that when early attacked 
 by proper means, there are few diseases of equal violence so en- 
 tirely under the control of medicine. 
 
OF WORMS. 481 
 
 CHAPTER XXXIII. 
 OF WORMS. 
 
 1618. There are few parts of the human, or even of the brute 
 body, which may not be infested with worms, if any reliance 
 can be placed upon the observations of philosophers and phy- 
 sicians. But our present purpose is only with such as infest 
 the stomach and bowels of children. 
 
 1619. It would seem to be agreeable to all observation, that 
 children are seldom without more or less of these animals; in- 
 deed, so common are they in the human bowels, that Dr. But- 
 ter has attempted to sustain a most extraordinary thesis upon 
 the subject. He declares them to be " nature's remedy for 
 destroying the superabounding morbid humours; and to stimu- 
 late the first passages, by their crawling motions, and there- 
 by assisting the peristaltic motion of the guts to carry off what 
 remains of the offensive load." 
 
 1620. As a general rule, we believe it entitled to confidence, 
 that children altogether confined to their mother's milk, never 
 have worms. This is, to be sure, contradicted by M. de Lille, 
 who affirms, that worms were expelled from his daughter, who 
 was only eleven months old, and who was altogether confined 
 to the breast. As regards our own testimony, we declare, we 
 have never seen worms in children under ten months old; and 
 only two inst-ances of that age: both of these children were 
 weaned at four months. 
 
 1621. From this, it would seem there is a protection against 
 these animals in the mother's milk, so long as the child is ex- 
 clusively confined to it; but the moment it leaves ityit becomes 
 obnoxious to them. It is pretty evident then, that these animals 
 are introduced into the stomach and bowels from without, by 
 means of the various articles of food upon which the child lives. 
 
 1622. Hence, children who live much upon crude aliment, 
 are more obnoxious to worms than those who are provided with 
 a constant supply of wholesome and nutritious articles of diet. 
 And, also, that those whose powers of digestion are strong, are 
 seldom troubled with these vermin. In feeble, or dyspeptic sto- 
 machs, these animals are not only much more common, but also, 
 
 61 
 

 4S3 OF WORMS. 
 
 much more mischievous; since, from the imperfect condition 
 of the gastric powers, the secretions permit them to remain un- 
 injured by its influence; and, also, that in feeble constitutions, 
 the secretions from the bowels themselves are never so freely 
 or entirely thrown off, as in robust frames ; and being retained, 
 offer a nidus at least for the engendering of these vermin; there- 
 fore, the best security against these animals is a healthy condi- 
 tion of the stomach and bowels, and a nutritious and invigo- 
 rating diet. 
 
 1623. Children who have access to crude unripe fruits, and 
 who do not restrain their appetites from indulging in them, are 
 particularly liable to suffer from worms; and this for two rea- 
 sons: 1st, because the ova of many are introduced by the food 
 itself;* and, 2dly, because the weakened powers of the stomach 
 permit them to be hatched, from the want of force in the gas- 
 tric liquor; for we have every reason to believe, that few ani- 
 mals can resist its influence, when in a state of perfect health. 
 
 1624. And upon the same principle, it can be readily under- 
 stood, how they can multiply and thrive, after they once have 
 possession of the stomach and bowels; especially as it is well 
 known they reside in the mucous secretion of these parts; and 
 how to the parts themselves they may become irritants, and 
 force them to a more abundant secretion ; and hence, from a 
 profuse supply of rich nourishment, they seem to thrive almost 
 beyond their natures, and can scarcely be recognised as speci- 
 mens of the class to which they belong. 
 
 1625. Almost every writer on the practice of physic men- 
 tions extraordinary examples of the kind; and both foreign and 
 domestic journals furnish like instances. And it would seem to 
 be a matter placed now beyond dispute', that many aquatic ani- 
 mals may gain possession of the stomach, either in the form of 
 
 * We are aware that the idea of the ova of worms being- introduced into the 
 stomach by fruit, and hatched there, is not believed by some, and even ridiculed 
 by others, because, say they, there is no similarity between the worms expelled 
 from the body, and the worms found in unripe or injured fruit— but this is taking 
 but a limited view of the subject; since, it is certain, that very considerable va- 
 rieties have been observed to pass per anum, and may, doubtless, have escaped 
 unnoticed. Besides, the difference in nourishment, and even, perhaps, a change 
 of habits may alter the form of these animals; the leech, it would seem, undergoes 
 a great change when introduced into the bowels and permitted to revel there, as 
 we shall notice below. 
 
OF WORMS. 483 
 
 ova, or in a viviparous state. Thus, the horse-hair worm, though 
 an aquatic animal, is frequently found in the stomachs of the pea- 
 santry of Lapland, and%introduced there, agreeably to Linnseus, 
 by drinking of the half putrid water of their ponds. 
 
 1626. After the same manner, the leech has been conveyed 
 into the stomach when minute and young, along with the muddy 
 and stagnant water they are known to inhabit. Of this kind is 
 the remarkable case related by Mr. Paisley, in Vol. II. Art. xxvi. 
 of the Ed. Med. Essays. And also of an analogous kind, is that 
 related by the late Dr. Bond, of this city, in the Lond. Med. Ob- 
 serv. and Inq. Vol. I. p. 6S. In the first of these instances, a 
 gentleman voided two animals of the leech kind, each measuring 
 a foot and a half in length, and an inch and a half in diameter. 
 In the second, a worm of twenty inches in length, was voided by 
 a woman, after great suffering, and of which she died. On open- 
 ing the body, it was found that the animal had worked its way 
 into the liver through the common duct, and committed great ha- 
 voc on that organ; after which it seemed to have travelled back, 
 and had forced its way again, with much difficulty, through the 
 same duct into the intestines, whence it was discharged dead, 
 and in two portions. 
 
 1627. It is in vain to urge that these animals cannot be intro- 
 duced from without into the human system, as the aliment and 
 mode of life must not only be different, but their habits must 
 also be destroyed, in a place of such confinement — the facts speak 
 for themselves. 
 
 162S. It is true, the cases just mentioned are exceptions to the 
 general inhabitants of the stomach and intestines; yet, perhaps, 
 there is nothing more marvellous in the one instance than in the 
 other; since we cannot admit, with our present data, that there 
 are varieties of worms, proper to the human stomach and bowels. 
 If they are extraneous, as we believe them to be, it only follows, 
 that the kind usually found, are much greater in number; more 
 easily introduced, or of more hardy habits; resisting and over- 
 coming the disadvantages of their new situation, and eventually 
 thriving and revelling in the plenty of their adopted habitation. 
 
 1629. The worms commonly found in the human body, are 
 divided into the "round," and the "flat." These are arranged 
 according to the disease or symptoms to which they give rise: 
 1st, those which can be nourished in any portion of thealimentary 
 
484 OF WORMS. 
 
 canal ; 2d\y, those which locate themselves at the lower extre- 
 mity of the canal ; 3dly, those which have no " local habitation," 
 and seem to have wandered there erroneously: hence, they are 
 divided into three species, and called, 
 
 1. Alvine worms, or Helminthia Alvi. 
 
 2. Anal worms, or Helminthia Podicis. 
 
 3. Erratic worms, or Helminthia Erratica. 
 
 Species 1. Of Alvine Worms. 
 
 1630. " Worms existing and finding a proper nidus in the sto- 
 mach or alvine canal, chiefly of children, and sickly adults; pro- 
 ducing emaciation, a swelled hard belly, gnawing or pungent pain 
 in the stomach, pale countenance, fetid breath, and irritation of 
 the nostrils." (Good, Vol. I. p. 200.) 
 
 1631. The worms which give rise to the above symptoms, and 
 inhabit the regions designated, arranged under the following 
 varieties: — 
 
 A — Long round worm, or Ascaris Lumbricoides.* 
 B — Long thread worm, or Tricocephalus.f 
 C — Long tape worm, or Taenia Solium. ± 
 
 * " The head of the long round worm is slightly incurvated, with a transverse 
 contraction beneath it; mouth triangular; body transparent; light yellow, with a 
 faint line down the side; gregarious, and vivacious; from six to fifteen inches long; 
 inhabits principally the ileum, but sometimes ascends into the stomach, and creeps 
 out of the mouth and nostrils; occasionally travels to the rectum, and passes away 
 at the anus." (Good, Vol. I. p. 200.) 
 
 f " The body of the long thread worm is, above, slightly crenate; beneath^ 
 smooth, finely striated on the fore part; the head obtuse, and furnished with a 
 slender retractile proboscis; tail, or thinner part, twice as long as the thicker, 
 terminating in a fine hair-like point, about two inches long: in colour, resembles 
 the preceding; gregarious, and found chiefly in the intestines of sickly children; 
 generally in the c*ecum." (Ibid. p. 201.) 
 
 ■i " In the long tape worm, the articulations are long and narrow, with margi- 
 nal pores, by which it attaches itself to the intestines one on each joint, general- 
 ly alternate.; ovaries arborescent; head with a terminal mouth, surrounded with 
 two rows of radiate hooks, or holders; and a little below, on the flattened surface, 
 four tuberculate orifices or suckers, two on each side; from thirty to forty feet 
 long, and has been found sixty. Inhabits the intestines of mankind, generally 
 at the upper part, where it feeds on the chyle and juices already animalized. Is 
 sometimes solitary, but commonly in considerable numbers; and adheres so firmly 
 to the intestines, that it is removed with great difficulty. It is said to have the 
 power of reproducing parts which have been broken off; but this assertion wants 
 
OF WORMS. 485 
 
 D — Broad tape worm, or Taenia Vulgaris.* 
 E — Fluke, or Fasciola.t 
 
 1632. As it is not necessary to our purpose, we have not 
 given a long technical description of each of these varieties, nor 
 shall we of the succeeding ones. We have mentioned them, 
 because they are more or less frequently met with in practice. 
 It may, however, be well to observe, that the first of these is 
 found much more constantly than either of the other varieties — 
 we would not, however, pretend to say in what proportion. 
 
 Species II. Anal Worms, or Helminthia Podicis. 
 
 1633. " Worms, or the l'arves of insects, existing and finding 
 a proper nidus within the verge of the anus, exciting a trouble- 
 some local irritation, sometimes accompanied by tumour, fre- 
 quently preventing sleep, and producing pain or faintness in the 
 stomach." (Good, Vol I. p. 203.) 
 
 1634. Under this species are included the following varieties: 
 
 A — Thread worm, ) . _.' / , . 
 
 , r or Ascaris Vermicularis.f 
 
 Maw worm ) 
 
 B — Beetle Grubs, or Scarabaeus,§ 
 
 C— Bots, or (Estrus.|| 
 
 proof. The animal is oviparous, and discharges its numerous eggs from the aper- 
 tures on the joints. The broken off joints have, when discharged, the appear- 
 ance of gourd seeds: and it is hence denominated gourd worm by many medical 
 writers; and is the lumbricus cucurbiiinus of Dr. Heberden." (Ibid. p. 201.) 
 
 * " The articulations of the broad tape worm are short and broad, with a pore 
 in the centre of each joint, and stellate ovaries round them; body broader in the 
 middle, and tapering towards both ends; head resembling the last; inhabits the 
 upper part of the intestines, and feeds on the chyle; from three to fifteen feet 
 long; usually in families of three or four." (Ibid. p. 202.) 
 
 j The body of the fluke is flattish, with, an aperture or pore at the head, and 
 generally another beneath; intestines flexuous: ovaries lateral; hermaphrodite, 
 and oviparous." (Ibid. p. 202.) 
 
 $ "The head of the thread worm is subulate nodose, and divided into three 
 vesicles, in the middle of which it receives nourishment; skin at the sides of the 
 body finely crenate or wrinkled, tail finely tapering, and terminating in a point; 
 gregarious; viviparous; about half an inch long; sometimes wanders into the in- 
 testines, and occasionally as high as the stomach." (Good, Vol. I. p. 203.) 
 
 § " This variety has not been accurately described:" "the following seem to 
 be the chief: gray larve, with yellowish legs, and ferruginous head;" "have six 
 feet; are annulate, hairy, vesicular at the end of the abdomen, and furnished with 
 a horny head." (Ibid. p. 204.) 
 
 H "The larves of the oestrus, breeze, or gad-fly, are called bots, and are of a 
 
486 OF WORMS. 
 
 Species III. Erratic Worms, or Helminthia Erratica. 
 
 1635. " Worms, or the larves of insects, introduced by acci- 
 dent, and without finding a proper habitation in the stomach or 
 intestines; producing spasmodic colic, with severe gripings; and 
 occasionally, vomiting, or dejection of blood." (Good, Vol. I. p. 
 205.) 
 
 1636. Of these worms, according to Dr. Good, but little is 
 known, though there is good authority for introducing them — 
 and we have been the more readily induced to follow him in 
 this particular, as we met with two distinct species, as we are 
 disposed to believe, in the same child, within a few days, and 
 altogether different from any we have hitherto seen. 
 
 Of the Treatment. 
 
 1637. We are but imperfectly instructed upon this point, and, 
 perhaps, will remain so, until practitioners shall be better able 
 to ascertain the effect of remedies on each individual species of 
 these animals, and shall learn to distinguish them by the symp- 
 toms they give rise to. The whole of the symptoms which 
 these vermin create, are familiarly said to be produced by 
 " worms;" and, it is probable, they do not yield the same va- 
 riety in effect, as their diversity of species would lead us to sup- 
 pose. Nor is this, perhaps, much to be wondered at, since the 
 whole train of symptoms to which they give rise, is produced 
 by an irritation imposed on some one portion of the alimentary 
 canal or stomach; and it would require greater power of dis- 
 crimination than is generally possessed, to detect the cause, or 
 the particular nature of the irritant. So general, and so uni- 
 form, for the most part, are the symptoms arising from almost 
 any irritation of the bowels,*, that one cause may readily be 
 mistaken for another: thus, we have frequently seen all the 
 symptoms usually attendant upon worms, completely similated 
 by the presence of acrid bile; and the reverse. Therefore, so 
 far are we from being able to detect the species of worms, that 
 we cannot say with perfect confidence that the symptoms are 
 the result of even the genus; since, as we have just observed, 
 other irritants may produce similar phenomena. 
 
 round figure; pale green-, tail obtusely truncated; head tapering; mouth horny, 
 with two lips, and two recurved black claws on each side of the mouth." (Ibid, 
 p. 204.) 
 
OP WORMS. 487 
 
 1638. Yet it is but reasonable to conjecture, that each species 
 may have its antipathies and even its poisons; and this would 
 seem to be strengthened by what is observed with some other of 
 the inferior animals, in the selection and rejection of certain ar- 
 ticles which may in their turn be food or poison, as it may be 
 one species, or another, that employs them. Thus, the deer eats 
 with impunity the deadly laurel; while the sheep is instantly de- 
 stroyed by it, &c. 
 
 1639. May not this diversity in what shall consist a wholesome 
 nutriment, or in what may constitute a poison, help us to account 
 for the extravagant encomiums bestowed by some upon an arti- 
 cle, as anthelmintic; and the disparaging accounts of the same 
 article, for the same purpose, by others? Is it not probable that 
 the success of the article, when it proved useful, depended upon 
 its being obnoxious to one species of worms; and its want of suc- 
 cess, to its not proving so to others? Is this not rendered still 
 more likely from the fact, that that which shall detach and expel 
 from the bowels lumbrici, shall not stir the taenia solium? 
 
 1640. We believe this to be more than conjecture — and it 
 would be well for practitioners, to record, with each successful 
 treatment of worms, the particular species, nay, if possible, the 
 variety of this animal ; the precise nature of the agent employed, 
 and the particular situation of the patient at the moment; to re- 
 cord any auxiliary remedies, if such there were; and to note 
 down any and every circumstance, that in his opinion may have 
 given efficacy to the plan which had been adopted. 
 
 1641. We have observed, (1637,) that the presence of any spe- 
 cies or variety of worm, gives the same kind of disturbance to 
 the system; and that at the present moment we cannot detect by 
 any peculiarity of symptoms, by what species the mischief is 
 created. Dr. Heberden has laid down the marks by which worms 
 may be suspected, (for it amounts to nothing more) in the follow- 
 ing order: — 
 
 1642. "The evils which hence arise, and which cease upon 
 their expulsion, are headachs, vertigo, torpor, disturbed dreams, 
 sleep broken off by fright and screaming, convulsions, feverish- 
 ness, thirst, pallid hue, bad taste in the mouth, offensive breath, 
 cough, difficult breathing, itching of the nostrils, pain in the sto- 
 mach, nausea, squeamishness, voracity, leanness, tenesmus, itch- 
 ing at the anus towards night, at length, dejection of films and 
 
48S OF WORMS. 
 
 mucus. The broad tape worms produce the severest mischief 
 on the body; while the terrestes and ascarides, (round and thread 
 worms,) sometimes lurk, scarcely suspected, unless there be an 
 itching of the anus, or they are traced in the faeces: — , 
 
 1643. Yet, what practitioner with all this long list of formida- 
 ble symptoms combining in one person, would risk his reputation 
 upon the event, that they were produced by worms? It must 
 be familiar to every body exercising the profession of medicine, 
 to meet with cases, in which so many of the enumerated signs 
 have combined, as to leave no doubt of the existence of worms ; 
 yet the issue of the case has not always verified the conjecture; 
 at least not by any direct evidence; such as the expulsion of 
 these animals. While, on the other hand, he has seen them 
 driven off in shoals, where a suspicion of the agency has scarcely 
 been awakened. 
 
 1644. Dr. Heberden has failed to mention a symptom, which 
 we believe was first noticed by Home; and which, when it exists, 
 for it is not always present, is less equivocal than any other we 
 have met with: namely, an osdematose swelling of the upper lip 
 and lower part of the nose. 
 
 1645. 'Worms injure the body they inhabit, in one of three 
 ways:— 
 
 1st. By irritation. 
 
 2dly. By destroying the nourishment intended for the sup- 
 port of the child. 
 
 3dly. By their bulk from accumulation. 
 
 1st. Irritation. 
 
 1646. When the stomach and bowels become irritated by the 
 presence of worms, there is scarcely a part of the body which 
 does not sympathize with it, and manifest its sympathy, by some 
 marked derangement of the part. Thus, the lungs have assumed 
 the appearance of consumption, by cough, hemorrhage, &c. ; the 
 uterus has been urged to flooding; the brain to mania, coma, de- 
 lirium; the nose to bleeding; the trachea to croup, &c. &c, if 
 any reliance can be placed upon the observations of authors. 
 
 1647. The production of cough is familiar; that of simulated 
 phthisis is more rare, yet met with. The uterus is but rarely, we 
 believe, involved ; not because it does not sympathize largely with 
 
I 
 
 OF WORMS. 489 
 
 many parts after puberty, but because tbe affections under consi- 
 deration are more common to early life, and, consequently, be- 
 fore this organ has received such development, as to render it a 
 sympathizing part or source. The aberrations in the functions 
 of the brain from this cause, almost every body has witnessed 
 A very remarkable instance of this kind fell under our notice 
 lately, which it may be interesting to relate. 
 
 1648. The daughter of T. P. R., aged eleven, was suddenly 
 attacked with fever and delirium. We were sent for, irame- 
 diatety, but being unwell, a friend visited her for us. She was 
 ordered to lose six ounces of blood, and to be freely purged by 
 calomel, &c. The following morning the delirium was increased ; 
 the fever equally high, though she had been liberally purged, 
 and the blood had been drawn: the blood showed no marks of 
 inflammation. She was ordered to lose six ounces more of blood; 
 to take small but repeated doses of calomel. In the evening, 
 every symptom was aggravated, or, rather, she was perfectly 
 comatose, from which it was difficult to rouse her even to take 
 drink ; her tongue was very dark and dry, as far as could be 
 ascertained by looking into the mouth, for she could not be 
 roused sufficiently to make her put it out; the pulse small, wiery 
 and frequent; the skin cold, but dry; no urine; the eyes half 
 closed ; stools of a very dark brown colour, and extremely offen- 
 sive, and passed involuntarily; in the last, while we were there, 
 a lumbricus was found. 
 
 1649. The case appeared a forlorn one; but we did not aban, 
 don all hope: blisters, sinapisms and wine whey, together with 
 an infusion of pink root, (the spigelia Marylandica,) were or- 
 dered for the night. On our visit, the next morning, seventeen 
 -lumbrici were shown us, that had passed a little while before. 
 The patient, in every respeet better; the coma much less; the 
 skin warm, but not febrile ; the pulse more open, and less fre- 
 quent; passed urine freely; had command of her evacuations. 
 
 1650. The pink root tea ordered to be continued; no other 
 medicine; wine whey to be withheld, and gum Arabic water 
 substituted. On our visit in the evening, we found seven more 
 worms had passed. The patient comparatively well — she ra- 
 pidly recovered from this moment 
 
 1651. In this case, it is evident the whole train of formida- 
 ble symptoms were produced by some peculiar irritation in the 
 
 62 
 
490 of WORMS. 
 
 bowels from the presence of worms; whether this irritation arose 
 from the motion of these animals upon the denuded bowels by H 
 destruction of their proper mucus ; or whether, from a deficient 
 supply of nourishment, they inflicted any mechanical injury 
 upon the bowels, may be very difficult to say; but we think it 
 every way probable, that their brisk motion against the internal 
 surface of the intestines, producing great irritation, or more or 
 less inflammation of the mucous coat of the latter, may account 
 for the extreme derangement of the system ; especially if they 
 had suddenly migrated from one part of the intestinal canal to 
 another. 
 
 1652. We have seen a number of instances where this change 
 of abode has been made: and this, most probably, being sudden- 
 ly performed, created prodigious disturbance in the system ; and 
 these cases are, perhaps, more frequent than is suspected. We 
 can best illustrate this position by the relation of a case. M. M.» 
 aged between four and five years, was suddenly attacked by in- 
 tense fever; face extremely red; skin burning hot; great thirst, 
 with considerable nausea; great delirium; pulse bounding; toge* 
 ther with a strong propensity t6 bite every thing presented to 
 him, or even his bed-clothes. The child was one naturally of 
 great vivacity; and, for his age, used a great deal of exercise, 
 and had never, until that moment, shown any signs of indispo- 
 sition, with the exception of fever from inoculated small-pox; 
 (this was in 1790:) he had been, until almost the moment of at- 
 tack, as cheerful and playful as usual. Living in the same house 
 with him, and being at home, we were requested to see him, 
 and we found him in the situation just described. 
 
 1653. From the suddenness of the attack, and the ferocity of 
 the symptoms, and especially as this was an indulged child, we 
 judged that his indisposition could only arise from some impro- 
 per article introduced into the stomach, either in the form of 
 food, or drink — from this view of the disease, we prescribed ten 
 grains of ipecacuanha, which was instantly administered ; and it 
 was equally prompt in its effects; the Very first effort brought 
 from the stomach one, and the succeeding discharge, two more 
 large lumbrici. These animals had hardly been ejected from 
 the stomach, before the whole of the unpleasant symptoms va^ 
 riished to return no more until twelvemonths after, when there 
 was a repetition of all those just enumerated. The same plan 
 
OF WORMS. 491 
 
 was pursued; and the same result followed. Another year pro- 
 duced a repetition in every respect like the two former; and the 
 same sudden cessation of symptoms followed the use of the 
 emetic. Since the above period, we have seen several other 
 cases, in every respect analogous to the one above described: 
 these cases give evidence, that the mere crawling of these ani- 
 mals over the surface of the stomach, may produce symptoms of 
 the most violent kind, and render it extremely probable that 
 the like may arise from a similar action on the tender surface 
 of the intestines. 
 
 2. By the Destruction of the proper Nourishment of the Child. 
 
 1654. From the little we know of the habits of these animals; 
 by their being almost constantly found to inhabit, or nestle in 
 the mucous secretion of the bowels; by their never, so far as we 
 recollect, being found attached to the coat of the intestines; from 
 the certain emaciation which is sure, sooner or later, to follow 
 their presence, it is every way presumable, that they feed in 
 part, if not altogether, upon the chyle intended for the support 
 of the system. Therefore, the injury to the child, on this sup- 
 position, will in general be, in proportion to the number and 
 size of these animals; hence the extreme attenuation of the body, 
 from a large number of lumbrici, and from the taenia solium. 
 Nor is this to be wondered at, when the former may be very 
 numerous; or the latter, of almost incredible length. 
 
 1655. They may also contribute to emaciation in an indirect 
 manner: 1st, by stimulating the mucous membrane to excessive 
 action, and oblige it to pour out an unusual quantity of fluid, 
 either for their comfort as a nidus, or for their support as a nou- 
 rishment; 2dly, by diminishing the appetite, and thus preventing 
 the common quantity of food from being taken; or, if there be 
 appetite, it is generally of an inordinate kind; forcing the stomach 
 to receive more than it can master, and consequently impair the 
 powers of this organ; so that it will neither digest a? much as 
 ordinary, or properly elaborate that, which it reduces to chyme. 
 
 1G56. It will be seen, that it will only be the "alvine, or er- 
 ratic" worms, which can produce great emaciation; the anal, 
 though creating great inconvenience, rarely produce emacia^ 
 lion; since they do not appear to live upon any other than the 
 
492 of worms. ; 
 
 stercal contents of the bowels, therefore, cannot occasion any 
 great waste >of the natural fluids. 
 
 3. By their Bulk from Accumulation. 
 
 1657. Worms may do much injury by their bulk; for their 
 numbers, as frequently happens with the asearius lumbricoides, 
 may become excessive. Of this we have seen numerous in- 
 stances, and they must be familiar to every practitioner. One 
 of the most remarkable cases of this kind which have falleii 
 under our own notice, we shall relate. A poor woman living 
 at the falls of Schuylkill, begged us, when near her house, to 
 look at one of her children, which she represented as being 
 almost in the last stage of human misery. 
 
 1658. The child, whom we now visited, was about twenty 
 months old; it had had during the whole of the summer, (our 
 visit to it was in September,) a diarrhoea, for which every known, 
 and almost every unknown remedy, had been tried in vain, as 
 regarded the relief of the child, though they abated the bowel 
 complaint. The child had cut most of its teeth, and was still 
 at the breast. It gradually wasted in its limbs and back, but its 
 belly seemed to increase in a direct ratio to the emaciation of 
 the other parts; it was literally nothing but skin and bones, with 
 the exception of the belly, which was enormously distended 
 and semi-transparent. It lay on its back, apparently without 
 power to move from its position. It appeared in great and con- 
 stant agony. 
 
 1659. Believing this to be a case of worms, we ordered half 
 an ounce of pink root in infusion; this to be given in small por-' 
 tions, as frequently as it would be received. On our visiting; 
 the child the next day, we were presented with a sight that was 
 truly appalling; ninety-six worms were shown us in a vessel ;. 
 the shortest of which measured six inches, and the longest ten* 
 Forty-five of these came away in one mass; the remainder at 
 several different efforts. The child required no other medicine; 
 nourishment soon restored its health.* 
 
 1660. Since worms may do injury in the several ways we 
 have just pointed out, it becomes a matter of great consequence 
 
 * We are told that one hundred and eighty lumbrici, from six to ten inches 
 each in length, were found in the jejunum and ileum of a child that died of scar- 
 latina.— Md, Chir. Rev. Nov, 15, Decern. 1823 = 
 
OF WORMS. 493 
 
 to expel them as certainly, and as quickly as possible. For this 
 purpose, an immense number of substances have been tried; 
 some of which, indeed we may say by far the greater propor- 
 tion, have failed, though ranked under the head of anthelmintics, 
 by systematic writers. It would seem, from the long list of arti- 
 cles exhibited by authors, purporting to possess anthelmintic pro- 
 perties, that many of them must have acquired this distinction, 
 from the mere contingency of these animals being expelled after 
 their exhibition, without their having any direct agency in their 
 extrusion; for, upon subsequent trials, they were not found to 
 possess any such power. While, on the other hand, some few 
 appear to be justly entitled to the reputation they have acquired 
 among practitioners, of almost every nation. Of this kind we 
 may mention, the Carolina pink root, (Spigelia Marylandica,) the 
 Jerusalem oak > (Chenopodium anthelminticum,) the cabbage- 
 tree bark, (GeoSVoya inermis,) the cowage, (Dolichos pruriens,) 
 the oil of turpentine, the male fern, (Polypodium filix mas,) ca- 
 lomel, and a few others. 
 
 1661. The whole of the anthelmintics may be classed under 
 three general heads: 1st, those which seem to possess some spe- 
 cific action upon the constitutions of worms, by a narcotic or 
 other power; 2dly, those which would appear to act upon their 
 bodies, mechanically; 3dly, those which seem to prevent, ei- 
 ther the development of their ova, in the oviparous kind; or 
 act in an unfriendly manner upon the young of the viviparous, 
 as soon as they are expelled from the matrices of the parents; 
 or by merely restoring to the bowels and stomach their lost tone. 
 
 1062. Under the first division, may be reckoned the pink root, 
 the Jerusalem bark, the cabbage tree bark, the male fern, the oil 
 of turpentine, and perhaps calomel. Under the second, we may 
 enumerate steel filings, tin filings, and the cowage. To the third 
 belong all the invigorating bitters, as tansy, rue, wormwood, gen- 
 tian, &c., the chalybeates, and the muriate of soda, or common 
 salt. . 
 
 1663. We have already observed, (1637) that we are not in 
 possession of the diagnostics of worms even as a genus, much 
 less the species, if we except the expulsion of them: we are, 
 therefore obliged to prescribe for these vermin, pretty much at 
 random, both as regards genus and species. In doing this, how- 
 ever, no serious mischief can arise : since, if the remedy be not 
 
494 OF WORMS, 
 
 exactly suited to the species, it only ends in a failure, without 
 doing any mischief, unless the anthelmintic plan has been inju- 
 diciously pursued, or too constantly persevered in. 
 
 1664. When we have reason to suspect worms to be the cause 
 of the symptoms for which we are desired to prescribe, it is 
 recommended by Dr. Good, to commence the course, by brisk 
 purgative remedies, with a view to remove from the bowels a 
 quantity of the mucus in which these animals are wont to bur- 
 row. We confess ourselves to have a high respect for the learn- 
 ing and talents of this gentleman, but at the same time, we must 
 declare it is a plan which has never succeeded in our hands; 
 nay, it has for many years been our deliberate opinion that it 
 even proves mischievous, by making these animals, if we may 
 so express ourselves, cling more closely to the bowels, by some 
 power or other, and thus disappoint the expectations of the prac- 
 titioner. We, therefore, never premise a purgative, when about 
 to assail these animals, but at once commence wifeh the remedy 
 we may select for trial, and persevere in it for a given time; 
 when this direction has been complied with" for a proper period, 
 we then give a carthartic: this may be either calomel, caster oil, 
 or an infusion of senna. 
 
 1665. The most decidedly efficacious remedy in our hands for 
 the long round worm, Ascaris lumbricoides, (1631) is the pink 
 root, in infusion ; and we can most safely declare it has rarely 
 failed where is has been faithfully administered. This remedy 
 has to contend against much prejudice; it is declared that the 
 most violent, nay, deadly symptoms have followed its use; as 
 convulsions, paralysis, vertigo, loss of sight, permanent headach, 
 &c. If such symptoms arise, (and there can be no doubt tha-t 
 they have,) they can only have proceeded from over doses of 
 this medicine: 5 * and if this be so, what medicine may not be 
 chargeable with similar evils from similar management? 
 
 * In almost every instance of which we could hear, with any certainty,, of mis- 
 chief following- the use of the pink root, it was owing 1 to over doses of this reme- 
 dy — we, therefore, are very particular in prescribing the quantity to be given: 
 for children, from one year to two, we give but two drams; for those from two to 
 five, we order one-third of an ounce; from five to twelve, we give half an ounce; 
 and, for adults, we never exceed six drams. We do not believe it safe to go be- 
 yond these doses; and we are certain, from often repeated trials, that these quarv 
 tities are sufficient, whenever this plant is the proper remedy. 
 
op worms. a 495 
 
 3666. We have prescribed this remedy many hundred times, 
 and we declare, we have never, except in a single instance, wit- 
 nessed any distressing symptoms to arise from it; in this excep- 
 tion, a slight squinting, with delirium, followed its exhibition: 
 but even in this case, the evils were very evanescent, for they dis- 
 appeared in the course of four or five hours. The mother of this 
 child informed us, that this plant had uniformly produced the 
 same symptoms in all her children. We are, therefore, of opi- 
 nion, that there is no good ground for rejecting this medicine, 
 upon the score of deleterious narcotic properties, whenever it 
 shall be given in proper doses, and at proper periods. 
 
 1667. An objection of another kind, however, may with more 
 success be urged against it ; namely, its bulk. Some, with a view 
 to diminish this, have given it in powder instead of infusion. 
 We have repeatedly tried this medicine in this form, but find it 
 does not lessen the difficulty. For a number of years past, we 
 have succeeded entirely, by exhibiting it in coffee, to such chil- 
 dren as may be in the habit of using this article of diet — but 
 with such as do not, the difficulty still remains. Might not an 
 extract be made, and still retain the valuable properties of the 
 plant? , 
 
 166S. Our plan for its use is as follows: pour upon the proper 
 quantity of the pink root, from half a pint to three gills of boil- 
 ing coffee, and permit it to stand, closely covered, until it be suf- 
 ficiently cool to drink. One half of this must be poured off, 
 sweetened, and have milk or cream added to it: when thus pre- 
 pared, the child is to drink it at its breakfast as if it were coffee 
 alone ; it may take with it bread and butter, &c, as in ordinary. 
 The other half is to be given in the evening in the same manner, 
 after warming it. This quantit}^ is to be repeated for three days 
 consecutively ; and, on the fourth, it must be followed by a pret- 
 ty brisk cathartic of calomel and jalap, castor oil, or senna tea. 
 We can say with much confidence, that this plan rarely fails, 
 unless the bowels are spontaneously opened, should there be 
 worms of the kind just mentioned. 
 
 1669. Should, however, no worms appear, and the symptoms 
 for which the pink root was prescribed continue, we are in the 
 habit of giving the worm-seed oil, (ol. Chenopod.) in appropri- 
 ate doses, provided there be no fever — should fever attend, this 
 remedy must not be thought of: in such case, small doses of calo- 
 
496 OF WORMS. 
 
 mel appear to answer best; therefore the pink root has a decided 
 advantage over the chenopodium, since it may be exhibited with 
 perfect safety even when fever is present. 
 
 1670. With young children who are not in the habit of using 
 coffee, the worm-seed oil is of more easy exhibition than the pink 
 root, and on this account, may merit a preference, where tbe 
 condition of the system will permit its use. The seed of the che- 
 nopodium is in familiar use in many places; and, it is said, with 
 decided advantage — of this we cannot speak from our own ex- 
 perience. The seeds are reduced to powder, and made into an 
 electuary with any sirup. Of this a child of two or three years 
 old may take a table-spoonful morning and evening, abstaining 
 for several hours from food. These doses must be repeated for 
 several days, if necessary. The seeds are also given on bread 
 and butter. 
 
 1671. Of the cabbage -tree, bark, we can say nothing from ex- 
 perience; and of the cowage, we can say nothing favourable, as 
 it failed in each of the few instances in which we tried it, though 
 the pink root succeeded afterwards. Of the other mechanical 
 remedies we know nothing: the tin has been highly extolled, and 
 may deserve a trial: but it would seem better calculated for the 
 tape worm, for which it has been principally recommended. 
 
 1672. For ascarides, (1634,) the aloetic medicines are certain- 
 ly the most useful. These worms produce more decided evi- 
 dence of their presence, perhaps, than any other; since the 
 troublesome itching at the anus, rarely arises from any other 
 *cause; besides, they can often be detected in the folds of the rec- 
 tum, by distending this part by pressing the nates from each 
 other, so as to open the sphincter ani; as well as in the evacua- 
 tions: especially after a costive stool. 
 
 1673. The attempt to dislodge these troublesome intruders, 
 is not always as successful as could be wished, particularly when 
 they are old inhabitants of the rectum. The plan we have hi- 
 therto found most certain, consists in the exhibition of small, 
 and often repeated doses of aloes. The preparation w T e are in 
 the habit of employing for this purpose, is the elixir proprieta- 
 tis, in doses suited to the age of the patient* After this has 
 
 * We give twenty drops of this medicine, morning, noon, and evening-, in a 
 
OF WORMS. . 497 
 
 been given for some time, enemata of lime-water,* camphoryf 
 or aloes,J should be had recourse to, which often destroys them 
 altogether. When the itching is very troublesome, the lime- 
 water injections relieve very decidedly, as does also a little tar- 
 ointment, forced within the sphincter ani. 
 
 1674. We have no certain marks to distinguish taenia (1631) 
 from other worms. From its immense length and peculiar ha- 
 bits, emaciation takes place more rapidly and extensively than in 
 the other genera and species of worms. A gnawing sensation is 
 often felt at the pit of the stomach, which nothing appeases but al- 
 most constant eating. The abdomen becomes tumid, and a sen- 
 sation like something, revolving in one portion of it, is sometimes 
 experienced ; more especially, in one of the sides. The head is 
 often affected with pain or vertigo; and, in females, a train of 
 most distressing nervous symptoms are produced : in one, we saw 
 repeated attacks of convulsions, resembling epilepsy, assail the 
 patient, from which she was not altogether relieved by the ex- 
 pulsion of the worm, which measured nearly seven yards. The 
 complexion becomes sallow and wan; the eyes sunken, with 
 widely dilated pupils. This worm, however, rarely attacks chil- 
 dren ; therefore, its treatment does not properly belong to us — 
 but for this we would make no apology, had we any thing new 
 to offer upon the subject of its cure. The remedies on which 
 the most reliance is at present placed, are the spirit of turpen- 
 
 little sweetened milk, to children from two to four years old; thirty, to those from 
 five to seven; and, to adults, a tea-spoonful. 
 
 * Lime-water may be used, of its ordinary strength, every evening: from half 
 a gill to a gill, (a little warmed,) will be sufficient. Dr. Darwall says, for the re- 
 moval of ascarides vermiculares, or thread worm, " The most useful injection is 
 composed of warm water and the tincture of the muriate of iron. Haifa pint of 
 the former, to half an ounce of the latter; and the whole of this thrown at once 
 up the rectum. There are few cases so obstinate, that this will not suffice to 
 overcome. It will be necessary to clear out the upper portion of the canal at the 
 same time, by an active purgative. — Plain Instructions for the Management of 
 Infants, &c. p. 99. 
 
 ■j- From five to ten grains of finely powdered camphor, suspended in a wine- 
 glassful of thin starch, may be given twice or thrice a week, at bed-time; or two 
 or three tea-spoonsful «f the camphorated spirit may be combined with the lime- 
 water. 
 
 * An enema of a tea-spoonful or two of the elixir proprietatis, in a wine-glass- 
 ful of warm milk, may be used two or three times a week at bed-time. 
 
 63 
 
498 OF WORMS. 
 
 tine,* the male fern, powdered tin, and the cowage. The worm 
 expelled by the lady who became epileptic, was driven off by 
 drinking every morning, for seven days, a pint of a saturated 
 solution of common salt.f 
 
 1675. Some children are very much more disposed to gene- 
 rate these vermin than others: so much so is this the case, in 
 many instances, that they may be said to be almost always pre- 
 sent. As the disposition to cherish these animals seems to con- 
 sist in a weakened condition of the stomach and bowels, we al- 
 ways make it a rule, with such constitutions, v to give tonic me- 
 dicines, after these animals have been expelled\ either in part, or 
 altogether. The best with which we are acquainted, consists of 
 equal parts of the carbonate of iron, and conKnon salt; from ten 
 to thirty grains, according to the age of the child, of this com- 
 pound, must be given for twelve consecutive mornings. It is 
 best exhibited in molasses; and should be taken early in the 
 morning, fasting. A diet of animal food, chiefly, should be ob- 
 served. Milk is also a very popular article of diet, at this time. 
 
 CHAPTER XXXIV. 
 OF SCARLATINA, OR SCARLET FEVER. 
 
 1676. This is so denominated, on account of the peculiarly 
 florid appearance of the skin, by which it is accompanied. In 
 some one of the several forms, which we shall presently see it 
 
 * We have, within a year, prescribed for a tape-worm, with great success, in 
 a very athletic man, when in health, but who had become much reduced by this 
 animal. He was ordered an ounce of castor oil, combined with as much of the 
 spirit of turpentine, once a week, for three consecutive weeks. The medicine 
 acted upon -his bowels with great force each time it was taken; and, each time, 
 brought away very large portions of the worm — nay, to the amount of many 
 yards. Since writing the above, this patient called upon us, under the appre- 
 hension that all the worm was not discharged. He was again directed to use the 
 same remedy, to which he readily assented. 
 
 f It would appear, that this worm is much more frequently met with in Eng- 
 land than in this country; as Dr. Darwall, (Plain Instructions for the Manage- 
 ment of Children, &c, p. 102,) says that his cases " exceeded some hundreds." 
 Louis reports ten cases; and our own proper experience would not allow us to 
 
OP SCARLET FEVER. 499 
 
 puts on, this complaint has, from an early period, occupied no 
 inconsiderable share of attention. It is frequent in its occurrence, 
 extensive* in its prevalence, and at times, exceedingly fatal in its 
 terminations. The complaint prevails more in winter and spring, 
 than in summer or autumn ; attacking children, in preference to 
 those who are more advanced in years.* By the nosological 
 writers it is divided into three forms, which are to be regarded, 
 however, as nothing more than the same disease, marked by dif- 
 ferent degrees of violence: — the scarlatina simplex — scarlati- 
 na anginosa— and scarlatina maligna. To many, the latter is 
 morefamiliarunder the name of the malignant, dr putrid sore throat. 
 
 1677. By scarlatina simplex, is to be understood, the simple 
 constitutional disease, without any morbid affection of the throat. 
 By scarlatina angitwsa, a higher degree of the same complaint 
 — the throat being at the same time inflamed and swollen. By 
 scarlatina maligna, the same disease, in still greater violence — 
 the throat being affected, or otherwise, and the symptoms ma- 
 lignant. 
 
 1678. It is unnecessary to enter into an elaborate discussion, 
 to establish the identity of the disease. 
 
 1679. Like most other fevers, scarlatina commences with 
 chilliness, fulness of the head, and lassitude; to which succeed, 
 prostration of-strength, which at times is very great; and nausea, 
 or vomiting. The surface soon becomes florid, and hot; and on 
 examining the throat, it will sometimes be found inflamed; and 
 the same red appearance extends to the tongue.t There is often 
 at this time, more or less catarrhal affection; the head suffers 
 severe pain, particularly about the frontal sinuses; and with 
 which is sometimes associated, a disturbance of the intellectual 
 faculties. The degree of these symptoms indicates, with suf- 
 ficient exactness, the strength and character of the forming dis- 
 ease. Being very slight, the- complaint will be simplex; if more 
 so, the anginosa: and where they are severe and threatening, 
 the maligna. 
 
 say with certainty, that we have met with more than a dozen cases, in more than 
 forty years of practice. 
 
 * Sir Gilbert Blane says that he never saw a person turned of forty, affected 
 by it. - 
 
 -j- This last presents a very peculiar aspect. Through the fur with which it is 
 covered, the elongated papillae project their points, and are of an intensely deep 
 scarlet blue. 
 
500 OP SCARLET FEVER. 
 
 1680. In the worst variety of scarlatina maligna, the com- 
 mencing symptoms are alarmingly violent. The attack is, for 
 the most part, sudden ; the patient becomes pale, sick, and faint; 
 the head is giddy, heavy, and confused, rather than severely 
 pained; the oppression about the prsecordia, is extreme; the 
 heart palpitates; the stomach suffers great uneasiness, though 
 there may be no vomiting— this organ being probably prostrated 
 below the power of reaction. The face is pale or lived; the eyes 
 exhibit a glairy appearance, and are marked by a fatuitous or 
 inebriated expression. * A remarkable tumefaction of the fin- 
 gers sometimes takes place, which, with the erysipelatous tinge 
 they soon acquire, is often of itself sufficient to characterize the 
 disease. ,, Gregory. This is seen also in some mild cases. 
 
 1681. On the second or third day from the commencement of 
 the disease, the febrile symptoms are considerable; the skin be- 
 comes morbidly sensible to the touch, and begins to be covered 
 with an efflorescence, or florid eruption.* About the same time 
 a degree of redness and swelling appear in the fauces. The skin 
 becomes excessively hot; more so, perhaps, than in any other 
 form of febrile disease. The pulse is also very frequent, rarely 
 being under one hundred and twenty strokes in a minute. 
 
 1682. The reaction of the system being now completely de- 
 veloped, the pulse exhibits the character which belongs to the 
 existing form of the disease — preternaturally frequent, quick, 
 and active, though still moderate, if the disease be simple — more 
 frequent, irritated and tense, if it be anginose — of greater fre- 
 quency still, but not so full, resisting, and firm, if it be malig- 
 nant. The temperature of the body, the thirst, the scurf on the 
 tongue, are also graduated in the same way; each symptom in- 
 creasing in intensity, according to the augmented violence of the 
 case. 
 
 1683. The eruption assumes, at times, the form of red points, 
 though generally, that of red patches, which spread and unite, so 
 as to cover the whole surface. It appears first on the face and 
 neck ; and in the course of a short time, spreads gradually to the 
 lower extremities. The redness is often considerable about the 
 loins, and the bendings of the joints, and on the hands and ends 
 of the fingers, which feel stiff and swollen. The eruption is not 
 
 * The tone of colour is said to be that of a boiled lobster. 
 
OP SCARLET FEVER. 501 
 
 very regular, either as to the time of its appearance, its steadi- 
 ness, or its duration. It usually continues about four days, and 
 goes off with desquamation of the cuticle. As the disease pro- 
 ceeds, the neck and lower jaw grow stiff, the tonsils swell and 
 become marked with specks which degenerate into ulcers, co- 
 vered with superficial, ash-coloured sloughs. These sloughs, in 
 favourable cases, separate and come off, about the eighth or tenth 
 day, when the ulcers underneath are fresh and florid, and heal 
 kindly. The fever, at the same time, gradually abates, and a 
 great amendment becomes apparent. 
 
 1684. But, in the more malignant cases, the course of the dis- 
 ease is very different. The sloughs on the tonsils grow fouler; 
 and the discharge from them, and the nostrils becomes exceed- 
 ingly acrid. The mouth assumes a dark colour, and is often in- 
 crusted with a black or brown fur. The breath is extremely of- 
 fensive; a tenacious mucous secretion infests the fauces. The 
 eyes and nostrils furnish an acrid serum. Hemorrhages some- 
 times take place from these parts, as also from the bowels; di- 
 arrhoea of a severe kind is often found present; so also delirium 
 or coma. If the throat be examined, it will be found studded 
 with more or less sloughs, with dark or livid bases. The paro- 
 tids are swelled and tender to the touch. Painful induration 
 of the glands of the neck, which sometimes terminate in large 
 suppurating abscesses; tenesmus, and diarrhoea; which sometimes 
 speedily sink the patient, if not early removed. 
 
 1685. This is reputed to be a contagious disease. On this 
 point, however, the evidence, to say the least, is equivocal. The 
 facts connected With the spreading of scarlatina, seem to be per- 
 fectly explicable, on the ground of its being epidemic, and not 
 contagious.* In this country the belief that, it is a contagious 
 disease, is by no means so general as it is in Europe, and espe- 
 cially as' it is in Great Britain. I have never seen, so far, any 
 decided proof that it has communicated itself in any one instance. 
 On the contrary, I am strongly disposed to doubt its contagious 
 
 * The weight of European authority is perhaps against us; and in actual prac- 
 tice, it will be safest to act under such a conviction. We are, indeed, told, that 
 the power of infecting endures for a very considerable time — certainly for a week 
 or two after the cessation of the efHorescenee, and probably as long as the des- 
 quamation of the cuticle lasts. Persons who have been exposed to the contagion, 
 have the disease, it is said, to break out on the fifth or sixth day. 
 
502 OP SCARLET FEVER. 
 
 quality. I attended a child with scarlatina anginosa, in a family 
 of eight children: the child that was ill was constantly surround- 
 ed by the well children, yet not one of these sickened afterwards 
 with this disease. The same thing precisely occurred in my own 
 family; besides many less remarkable instances. Gregory says, 
 " The slowness of its diffusion is one of the most remarkable cir- 
 cumstances in its history." Vol. I. p. 237. 
 
 1686. As regards the prognosis, it is unfavourable in propor- 
 tion to the malignant character of the disease. Thus, great pros- 
 tration of strength; delirium; or coma; extreme restlessness ; a 
 distillation of very acrid sanies from the nose; a purple or livid 
 appearance of the fauces, without tumefaction, interspersed with 
 white specks, or dark sloughs, attended by diarrhoea of acrid 
 matter; and above all, a change of the efflorescence to a mahogany 
 colour, are mortal, or extremely alarming symptoms. The ter- 
 mination of this disease is sometimes exceedingly abrupt and un- 
 expected. We have known death to take place, in several in- 
 stances, and this most suddenly, where every hope was enter- 
 tained of recovery,* but a short time before. The favourable 
 signs in scarlet fever are, the patient surviving the ninth day, 
 without any decided mortal symptoms; the intensity of the colour 
 of the skin abating gradually; desquamation of the cuticle, and 
 the departure of the swelling from every portion of the body to 
 which it had extended ; the separation of the sloughs, with a 
 healthy appearance of the parts from which they separated ; 
 pulse becoming slower and less irritated; heat, abating; urine 
 depositing a lateritious sediment, refreshing sleep, and return of 
 appetite. 
 
 1687. In its simple form, searlet fever calls for very little me- 
 dical aid. An emetic of ipecacuanha or antimony; purging with 
 calomel, and afterwards with some one of the neutral salts ; vene- 
 section, in case of fulness and pain in the head ; the mild diapho- 
 retics, aided by diluting drinks ; and a regulated diet,f are all we 
 
 * When the disease is very malignant, death sometimes takes place on the third 
 or fourth day; while, in its milder forms, it will linger on to the second, or even 
 third week. Generally, however, the patient is safe after the ninth day, under 
 e ther form of the disease. 
 
 f By a regulated diet, we mean a strict antiphlogistic one; that is, an entire for- 
 bearance from animal food; from every kind of liquor, whether fermented or dis- 
 tilled; and from spices of every species. 
 
OF SCARLET FEVER. 503 
 
 need prescribe. But in the anginose state of the disease, more 
 is required — the treatment, here, must be circumspect and vigo- 
 rous; and much reliance is to be placed on the thorough evacua- 
 tion of the alimentary canal. Unless, as is sometimes the case, 
 the violence of the symptoms calls for the immediate use of the 
 lancet, let the treatment commence by pukkig with the ipeca- 
 cuanha. Emetics are of the highest importance; and may 
 sometimes be repeated during the course of the disease, should 
 the symptoms be obstinate. 
 
 168S. The emetics should be followed by laxatives. Calomel 
 would seem to be the most suitable, on account of its tendency 
 to prevent, and remove congestions of the abdominal viscera, 
 which are much to be dreaded, and vigilantly guarded against, 
 in this disease. This is a disease in which congestions of the 
 great viscera, are very apt to occur; and requires mercurial 
 purging to unload the vessels, and restore the balance, which is 
 thus destroyed in the circulation. In the more advanced stages 
 of the disease, however, provided the bowels have been already 
 fully evacuated, some of the milder purgatives may be employed. 
 The best mode of exhibiting calomel is in divided doses — say, 
 six or eight grains divided into six parts; one part to be given 
 every hour, until the whole be taken; unless the previous quan- 
 tity may have answered. Should this quantity, however, fail 
 to move the bowels, it must be followed by two or three tea- 
 spoonsful of calcined magnesia, mixed in a little sweetened 
 milk, and drinking after it some lemonade. 
 
 1689. In case the pulse be full, tense or hard, immediate re- 
 course is to be had to venesection. The quantity of blood drawn, 
 and the repetitions of the operation, are to be directed, of course, 
 by the judgment and experience of the practitioner. The relief 
 felt by the patient, the appearance of the blood, and the effect 
 on the pulse, must determine whether it shall be repeated — the 
 bleeding must be followed by purging. In the early, or inflam- 
 matory condition of scarlatina, however, when there is considera- 
 ble arterial action, and vast augmentation of heat on the surface, 
 cold ablution, or sponging, gives great relief to the symptoms, 
 and is a most comfortable process. We prefer, however, 
 sponging to ablutions. Some, however, are afraid of these cold 
 applications, because the throat is sore; but this forms no ex- 
 ception; for it is not accompanied by cough or other pneumo- 
 
504 OF SCARLET FEVER. 
 
 nic symptoms, like measteJ; and the sponging, or even effusions 
 has checked the sore throat mostrevidently. We would how- 
 ever make an exception to the employment of cold water, &c; 
 when they produce chilliness: in this case, tepid water may be 
 substituted. 
 
 1690. We are told the warm bath is exceedingly efficacious, 
 when the eruption imperfectly takes place, owing to general lan- 
 guor; and, especially, when attended by coldness of the surface — 
 or, having appeared, suddenly recedes, inducing great gastric 
 distress, and other very unpleasant symptoms — to cleanse the foul 
 ulcers of the throat, emetics are found most effectual — the erne- 
 tic may be followed by the use of detergent gargles; the best of 
 which are composed of Peruvian bark, with a portion of the 
 tincture of myrrh — or, barley water, acidulated with the sul- 
 phuric or muriatic acid, with the addition of honey. An infu- 
 sion of Cayenne pepper, alone or mixed with barley water, or 
 the decoction of bark, is much, and we have reason to believe, 
 not too much, praised as a gargle,* as far as we can rely on our 
 own observations. 
 
 16.91. In the malignant form of this disease, the general prac- 
 tice is nearly the same as in the preceding or anginose state. 
 We rety, mainly, on evacuations, of the primse via — first, by 
 emetics, and next with the mercurial purges.t 
 
 1692. Whatever may have been the primary form of the 
 disease, in the advanced stages, when appearances of great de- 
 pression supervene, we have recourse to nearly similar measures. 
 The object is to support the enfeebled system, which is best ac- 
 complished by the carbonate of ammonia, camphor, turpentine? 
 bark, and wine — aided by the ordinary external irritant appli- 
 cations. 
 
 1693. Long after the cessation of the active symptoms, there 
 are certain consequences show themselves, to which our atten- 
 tion should be immediately called. Deafness is one of these: 
 this proceeds from inflammation having invaded the Eustachian 
 
 * We are in the habit of using Cayenne pepper gargle in the incipient stages 
 of anginose affections, with the most decided advantage; and, in the disease un- 
 der consideration, it seems to us to be the only remedy that affords relief, if ulce- 
 ration have not taken place. 
 
 f See American Journal of Medical Sciences, for August, 1833, for Dr. Jack- 
 son's account of the use of ice in this disease. 
 
OF SCARLET FEVER. 505 
 
 tube, and leaving it in a state of obstruction. It is an unpleasant 
 affection, though we have never known any permanent mischief 
 to result from it; it requires no treatment* (Edematous swell- 
 ings of the lower extremities are common, as well as more se- 
 rious inconveniences. The best treatment is to purge moderate- 
 ly, and afterwards exhibit the digitalis. It is here that this drug 
 sometimes proves pre-eminently beneficial. But in the removal 
 of the effusion, it may be aided by frictions and bandages, if the 
 swelling be large, and by exercise duly regulated, and perse- 
 vering in a milk and vegetable diet. We have known the in- 
 flamed parotids run on to extensive suppuration, and require 
 much time for healing. When this takes place during the con- 
 tinuance of considerable fever, and the parts exposed by slough- 
 ing look as if they had been carefully and beautifully dissected, 
 death has constantly followed, as far as our observations have 
 extended. 
 
 1694. Dropsical affections frequently succeed to scarlet fe- 
 ver; this takes place after the mild, as well as after the severer 
 Form of this disease. We are inclined to believe, that this af- 
 fection arises from the accompanying inflammation not having 
 teen properly subdued by early depleting remedies. In con- 
 sequence of this, the inflammation acquires a chronic, or a sub- 
 acute form, which is only relieved by purging, by blood-letting, 
 and diuretics of the saline kind; as nitre, or nitre and squills. 
 For children under seven years, and above three, we would 
 give eight grains of nitre, and one-fourth of a grain of squills 
 three or four times a day. For those above seven to fifteen, 
 twelve grains of nitre, and half a grain of squills may be given; 
 from fifteen to adult age, from fifteen to twenty grains of nitre, 
 and a grain of squills may be^administered. 
 
 * Dr. Gregory, however, states, that " not unfrequently permanent deafness is 
 left by it." Vol. I. p. 240. Of this, however, we have never seen an example. 
 
 G4 
 
506 OF MEASLES. 
 
 CHAPTER XXXV. 
 
 OF MEASLES, OR RUBEOLA. 
 
 1695. This disease occurs, for the most part, in the winter 
 and in spring; at least, its appearance is much more frequent at 
 these periods than at other portions of the year. It may, how- 
 ever, prove epidemic in the summer. This disease is evidently 
 influenced by the state of the weather; it is more moderate in 
 mild, than in severe weather. 
 
 1696. It is the opinion of some, that measles is regular in its 
 recurrence as an epidemic; the interval is said to be seven years. 
 Whether this be rigidly the case, we are not prepared from pre- 
 sent data to decide: it is, however, rendered probable that there 
 is either a regular return at this period, or, at least, an approxi- 
 mation to it. 
 
 1697. It is said to be contagious; but this may be pretty fair- 
 ly disputed, notwithstanding the imposing experiments of Dr. 
 Home. This physician declared he had propagated this disease 
 by inoculation. An Italian physician, (Speranza,) declares he 
 has succeeded in an attempt at inoculation by puncturing a full 
 measle with a lancet, and inserting the blood that was yielded 
 by the puncture — he declares he was successful in six cases. On 
 the other hand, Dr. Chapman (MS. lectures,) says upon this 
 point, that " experiments of this nature were instituted in the 
 practice of our Dispensary in 1801; in which the blood, the tears, 
 the mucus of the nostrils, and bronchia, the eruptive matter in 
 the cuticle, properly moistened, were all tried, and without suc- 
 cuss in any one instance.""' 
 
 1698. Neither is it settled, whether the constitution can be 
 made to suffer the rubeolous action a second time; evidence is 
 so entirely contradictory on this point, that it would not be safe 
 to draw a positive conclusion either in favour or against it. One 
 thing, however, we may safely declare; that if it be taken a se- 
 cond time, it is contrary to the ordinary character of this disease;* 
 
 * There is a variety of this disease, however, which affords no protection 
 against the genuine measles; thisis called the French measles, or the rubeola sine 
 
OF MEASLES. 507 
 
 or, in other words, it is but an exception to the general rule, as 
 regards several of the diseases which propagate themselves by 
 specific contagion, as small-pox, cow-pox, hooping-cough, chick- 
 en-pox, &c. For it is now well ascertained, that exceptions do 
 occur — we have ourselves known each of the diseases just enu- 
 merated, repeated seemingly so unequivocally as to leave no 
 doubts in our mind upon the subject. 
 
 1699. The measles are ushered in like other febrile affections 
 by chilliness, languor, oppression, heat, and thirst, especially the 
 first day: these terminate in a perfectjh^well-formed fever, and 
 sometimes by sickness, and even vomiting. The fever is pretty 
 high from its first assault, but not regularly so; occasionally it 
 would seem to augment for two or three days together, and be- 
 comes very considerable at the time the eruption makes its ap- 
 pearance; which, usually, is not before the fourth day. 
 
 1700. Cough, a little hoarseness, slight sore throat, pain in the 
 chest, and difficulty of breathing, are the usual attendants upon 
 this disease. The eyes are particularly affected ; they are almost 
 always slightly inflamed, and the lids a little swelled; and these 
 are attended by a plentiful secretion of scalding tears. Sydenham 
 looks upon these symptoms as the most certain marks of the ap- 
 proach of the measles. The discharge from the nostrils is also 
 abundant, as well as acrid, sometimes. Sneezing is almost a 
 never-failing attendant upon this complaint. ,,r— *^_ 
 
 1701. The eruption almost always occupies the face and neck 
 before it is observed elsewhere; it, however, for the niost part, 
 spreads itself successively over the whole body. But should this 
 not strictly occur, and the eruption show itself in "large red 
 spots, not rising above the surface," it may, nevertheless, be a 
 genuine measles.* This eruption is mostly very florid, and it 
 retains this colour for the first three or four days, after which 
 time it becomes brownish, and then gradually vanishes: this is 
 followed by a desquamation of the cuticle. " These red spots 
 are composed," agreeably to the same author, "of small red pim- 
 ples, seated near each other, and rising a little higher than the 
 
 catarrho. Dr. Gregory says this "is a very rare variety, and only interesting in 
 a pathological point of view." We have had several opportunities to see this form 
 of measles. Dr. Hosack witnessed it in 1813 in New York. It lias never required 
 any active treatment so far as we have .observed, «s*v 
 
 * Sydenham, Vol. I. p. 257. 
 
50S OF MEASLES. 
 
 surface of the skin, so that they may be felt upon pressing them 
 lightly with the finger, though they can scarcely be seen."** 
 
 1702. The eruption does not much abate the severity of the 
 fever; at least the heat of the skin remains equally great, and 
 especially that of the head and neck, both of which have a look 
 of greater fulness than is natural. Sometimes, however, an abate- 
 ment of fever may be observed after the completion of the erup- 
 tion ; but, for the most part, it does not entirely cease until the 
 cuticle is cast off. The vomiting which usually accompanies, or 
 ushers in the disease, always ceases at this period ; but the fever 
 and cough seem rather to augment, and is very frequently ac- 
 companied with drowsiness. 
 
 1703. We have said cough was an attendant upon this com- 
 plaint; indeed, it may be said to be of never-failing occurrence. 
 It is in the commencement dry, frequent, and sometimes pain- 
 ful ; but as the fever declines, it becomes more open, and often- 
 times the expectoration is even great. 
 
 1704. Pneumonic symptoms very frequently attend measles; 
 and sometimes this disease, when epidemic, is characterized by 
 this tendency. We remember it to have been epidemic, early in 
 the spring of 1785 or 1786 ; — at which time almost every case was 
 marked by pneumonic symptoms, of greater or less violence. 
 This disease w T as of difficult management; it ran its course with 
 unusual rapidity; and notunfrequently terminated in death; and 
 fn all instances almost, the cough was severe, obstinate, and of 
 very long duration. Indeed, in many cases, it yielded but to 
 the genial heat of advancing spring, or even that of summer. 
 
 1705. The only disease with which measles can well be con- 
 founded is scarlatina; yet it is pretty easily distinguished from it 
 by attending to the characters of each. The sneezing, the wa- 
 tery eyes, the severe cough, the pneumonic tendency, all serve 
 to distinguish the measles from scarlatina. Besides, in measles, 
 riiere is less swelling in the skin ; the redness is not so uniform, 
 nor is the tone of colour precisely the same. For in scarlatina, 
 the tone of colour on the skin is much more vivid than in 
 measles, and seems to lie beneath the cuticle — it is truly a scar- 
 let colour. In measles, the eruption has a mixture of the Mo- 
 dena with the scarlet — that is, it has a shade of purple. Besides.,. 
 
 * Sydenham, Vol. I. p. 257. 
 
OP MEASLES. 509 
 
 in measles there is a little roughness to be perceived if the hand 
 be slowly passed over the skin that is occupied by the erup- 
 tion; which is not the cas^e generally, indeed very rarely, with 
 scarlatina. 
 
 1706. In measles the eyes are much more sensible to light, 
 and are very much more tearful, than in scarlatina; nor are the 
 fauces so much affected in the former, as in the latter, disease. 
 Indeed, we have seen many cases of genuine measles without 
 the throat being at all affected, which rarely happens with scar- 
 latina. In measles, there is less certainty of a desquamation of 
 the skin. In the former, it more resembles a branny scurf, than 
 a true desquamation. ^^ 
 
 1707. As regards the prognosis, it may be observed, that this 
 disease is dangerous in proportion as the head, the lungs, and 
 the stomach may be affected. And in habits disposed to con- 
 sumption, it is always bad; at least, it is always to be feared. 
 
 1708. Much fever without a corresponding quantity ofjprup- 
 tion ; or the latter making its appearance reluctantly, or of a pale 
 or livid colour, is always a bad sign, and is usually attributed to 
 a want of vigour in the constitution ; but this is not so without 
 exception; or, perhaps, it is very rarely the case. We shall 
 again advert to this condition, presently. 
 
 1709. The abrupt disappearance of the eruption, or its be- 
 coming pale, is unfavourable; especially during the first day or 
 two of the eruption; or, if it be attended by a severe vomiting 
 a great tenderness of the epigastrium, or a diarrhoea.' Should 
 none of these untoward symptoms take place, the case will most 
 probably terminate propitiously. But we must be upon our 
 guard not to mistake the ordinary progress of the disease, for a 
 retrocession of the eruption. For, as the disease usually runs 
 its course in eight or nine days, the eruption is observed to^T 
 appear pretty generally at this time, which by the ignorant is 
 supposed to have taken place much too soon, and with a vievvito 
 maintain it upon the skin, stimulating drinks and medicine are* 
 freely exhibited; the patient is covered warm from head to foot, 
 and every avenue for air carefully shut up. In consequence 
 of such treatment, the patient is thrown suddenly into immi- 
 nent danger — fever is rekindled ; cough and other pneumonic 
 symptoms increase ; and the eruption assumes a livid or black 
 hue, and, if not soon relieved by proper treatment, the patient 
 quickly dies. 
 
510 OP MEASLES. 
 
 1710. Measles seems to be more decidedly attended by that 
 condition of the system called inflammatory, than almost any 
 other of the eruptive diseases; or, in other words, its epidemic 
 character is more frequently inflammatory than otherwise. 
 There are exceptions, of course, imposed by constitution, and 
 season of the year; but, above all, by the epidemic peculiarity 
 of the atmosphere: hence, it is sometimes highly inflammatory; 
 requiring the most active evacuations, and extensive depletion 
 by blood-letting, &c, to keep it in control; while, again, it 
 may have a highly malignant character; for the relief of which, 
 we must have recourse to the opposite means. Sydenham, how- 
 ever- did not order bleeding in the beginning, nor even at the- 
 height of this affection, though so fond of this remedy, under 
 almost every circumstance, at other periods of the disease. This, 
 in our opinion, shows how discriminating this great man was — 
 for he would not prescribe* for the name of a disease: the epi- 
 demic of 1670 does not appear to have been highly inflamma- 
 tory, as a strict antiphlogistic regimen-, with demulcents, he in- 
 forms us, te seldom failed to cure the disease." 
 
 1711. Therefore, regard must be had to the character the 
 measles assume, and must be treated accordingly — if fever be 
 high, cough and oppression severe, blood should be drawn im- 
 mediately, though these symptoms occur at rather an uncom- 
 mon period of the disease, namely, in its forming stage; for 
 such changes may be imposed upon the character of measles by 
 some constitution of the air, or other cause, as to render this 
 operation occasionally necessary. 
 
 1712. From this view of the constitutional differences of 
 measles, it will at once appear, that its treatment must vary ac- 
 cording to its specific character; or its form may be so mild as 
 to require no medical treatment. We have been under the ne- 
 cessity of bleeding only once this season for this disease, though- 
 we have prescribed for more than one hundred, up to this time; 
 
 n **fApril, 1829,) so mild has the character of measles been. 
 
 1713. In attacks of severity, especially where much cough, 
 oppression, or pain in the chest attend, the first remedy we can 
 profitably use is blood-letting; the quantity must be regulated 
 by the age of the patient, the force of the disease, and the im- 
 mediate effect of the remedy. It must, however, be remarked, 
 that in measles* though we are obliged to repeat this operation, it 
 
OP MEASLES. 511 
 
 rarely requires large quantities to be drawn at a time: and the 
 repetition must be governed by the state of the pulse, and con- 
 tinuance of the violent symptoms. 
 
 1714. Much objection is made to bleeding in the measles by 
 some: this fear is without foundation in most cases of this com- 
 plaint; for, as a general rule, we may declare, that there are few 
 diseases which more decidedly require this remedy; as there are 
 few in which the lungs are so seriously implicated. Under the 
 best management, it is but too apt to leave a troublesome and 
 obstinate cough behind ; but this is sure to be augmented, if blood- 
 letting has been neglected where the case required it; and we 
 may most safely add, that this but too frequently happens; since 
 this operation is too often proscribed. 
 
 1715. It is true, if w T e are to believe authors, that now and 
 then, the character of this epidemic is such, as to forbid, in al- 
 most every case, blood-letting; but this is but the exception to 
 the rule. And we are disposed to believe, that these exceptions 
 in many instances have been imaginary; or rather, that the true 
 mode of treatment has been ill understood. Sydenham appears 
 to us to be authority for this belief; for we are of opinion that 
 few would have bled under the circumstances, which he declares, 
 he found the maid servant of " Lady Anne Barrington, who had 
 the measles, joined with fever, difficulty of breathing, purple 
 spots over the whole body, and many other dangerous symptoms ; 
 all of which," says he, "I ascribed to the hot regimen and me- 
 dicines which had been too freely used. I directed bleeding in 
 the arm, and prescribed a cooling pectoral ptisan to be taken 
 often; by means of which, and a more cooling regimen, the 
 purple spots, and all the other symptoms went off by degrees," 
 p. 264, Vol. I. There are few diseases whieh put on a menacing 
 appearance, that are worse treated than measles; especially when 
 the eruption is about to make its appearance. Should this fail 
 to be as rapid in its progress, or as extensive in its diffusion, 
 as meets tho views of somo old woman, or ignorant nurse, the 
 disease is almost sure to be converted by stimulating applica- 
 tions, into one of danger, however simple it might have proved, 
 had its course and tendency been undisturbed. With a view 
 to promote an eruption, heating teas of various kinds, and even 
 liquors are given, to the certain injury, if not to the absolute 
 destruction of the patient — this conduct cannot be too strongly 
 reprobated, or too peremptorily forbidden. 
 
512 OF MEASLES. 
 
 1716. The same error is committed almost always, where the 
 eruption seems tardy, or reluctant in its appearance; for it is 
 wrongly imagined, that this can only proceed from a want of 
 force in the system, and that the efforts of nature must be se- 
 conded by heating teas of various kinds, wine whey, milk-punch, 
 &c, when nothing could have relieved the oppressed system but 
 blood-letting, and other evacuating remedies; and, hence, we are 
 disposed to believe, this disease so frequently proves fatal. For 
 if the pathology of the measles now so generally assumed, be 
 true, the cause of the eruption not appearing upon the skin may 
 be owing to the intensity of the gastric irritation or inflamma- 
 tion, as we have already attempted to explain, and which may 
 require the loss of blood, either from the system at large, or 
 from over the region of the stomach, by leeching, or cupping. 
 
 1717. In aid of the bleeding, we should employ calomel, so as 
 to freely discharge the bowels, without urging them to brisk 
 purging. And also to prescribe a strict antiphlogistic regimen; 
 together with demulcent drinks, as flaxseed tea, barley water, 
 bran tea, gum Arabic tea, &c. It may also become necessary, 
 where the pneumonic symptoms continue after bleeding, to draw 
 blood from near the seat of the local affection by cupping, and 
 this to be followed by a blister. 
 
 1718. When the system is sufficiently reduced to bear opium 
 in some form or other, it should be administered, so as to ap- 
 pease the cough, which but too often is very distressing.* 
 
 1719. One of the best forms of giving opium, is that of the 
 iQ black drop," or the acetated tincture of opium. This should 
 be administered at night, in combination with antimonial wine, 
 in suitable doses — for instance, a child from two to four years of 
 
 * We Lave found the following" mixture answer admirably well: — 
 
 Sperm. Ceti. 
 
 3*iss. 
 
 lake Of Spermaceti 
 
 1| drams. 
 
 Vitel Ovi. 
 
 J- 
 
 Yelk of an egg 
 
 One. 
 
 Pulv. G. Arabic 
 
 3& 
 
 Powdered Gum Arab. 
 
 2 drams. 
 
 Elix. Paregor. 
 
 £vi. 
 
 Paregoric elixir 
 
 6 drams. 
 
 Vin. Antim. 
 
 ^ss. 
 
 Antimonial Wine 
 
 4 drams. 
 
 Sacch. Alb. 
 
 oiij- 
 
 White Sugar 
 
 3 drams. 
 
 Aq. Font. 
 
 3vj. 
 
 Water 
 
 6 ounces. 
 
 
 M. 
 
 
 M. 
 
 Of this a table-spoonful is to be given every two or three hours, until the cough 
 be relieved. This dose is calculated for an adult — for children the quantity must 
 be proportional. 
 
OF MEASLES. 513 
 
 -sge may take three or four drops of the black drop, with ten of 
 antimonial wine at bed time: and, should this not relieve the 
 cough, and appease the inquietude, in two hours it may be re- 
 peated — for children more advanced, we must increase the dose 
 a little. But a few trials of rather an underdose will soon lead 
 to the knowledge of the required quantity. 
 
 1720. For children under two years old, we have found the 
 sirup of poppies to answer admirably. This may not only be 
 given at night, but also in the day, and may most advantageous- 
 ly be repeated, as the necessity arises^ from a small tea, to a 
 pap-spoonful, will be sufficient for a child from six months to 
 two years old. 
 
 1721. Should the character of this disease be typhoid,* the 
 lancet must be sparingly used, and perhaps, not at all, except in 
 the beginning; but when there is much oppression or pain in the 
 chest, with much cough, cupping will be found both necessary 
 and advantageous — this must, for the most part, be followed by 
 blistering. 
 
 1722. Emetics are also useful in this species of measles, and 
 should be employed where there is a great accumulation of 
 phlegm, and the expectoration but inconsiderable. Mercurial 
 purges are also to be given, even to plentiful purging. It is use- 
 ful also sometimes to employ the warm bath, especially where 
 the character of the eruption is not sufficiently healthy; looking 
 either to pale, or livid, provided the pulse is not so active as to 
 require bleeding. 
 
 1723. Should the appearance of exhaustion supervene, we 
 must have recourse to the diffusible stimuli; as wine whey, and 
 the volatile alkali: and these may be aided by blisters to the ex- 
 tremities, or by sinapisms to the soles of the feet. 
 
 1724. It is of much consequence throughout the whole course 
 of this disease, that the temperature of the air of the patient's 
 chamber should be regulated, and not made to exceed sixty-four 
 or five; sixty, perhaps, would be the best standard. This tem- 
 perature would be warmer than would be useful for small-pox — 
 measles requires this; but it is never proper to keep the pa- 
 tient hot, by either a heated atmosphere or bed-clothes. The 
 
 * We are of opinion that too much care cannot be taken, not to confound what 
 is termed "a typhoid condition," with an existing- inflammatory condition of the 
 system: witness the case related by Sydenham, p. 489. 
 
 05 
 
514 OF MEASLES. 
 
 constant disposition to cough, will readily explain why measles 
 requires a higher temperature than small-pox. Dr. Gregory ob- 
 serves, that " it is well ascertained that these, (the symptoms of 
 thoracic inflammation,) are often aggravated by a free exposure 
 of the body to cold, either during or previously to the eruption; 
 and some have remarked, that this aggravation of the catarrhal 
 symptoms is occasionally attended by a recession of the erup- 
 tion. Moderate warmth, therefore, is on all accounts advisable 
 in measles." 
 
 1725 Measles but too frequently leave disagreeable consc 
 quences behind them, especially cough. This secondary or su- 
 pervening cough, is too often neglected, owing to the belief that 
 more or less must necessarily follow this disease. This affection 
 takes place after the patient has gone through the eruptive stage; 
 and dissection reveals that it is owing to an inflammation having 
 attacked the mucous membrane of the bronchia. This complaint 
 comes on sometimes so insidiously, that it makes a fatal progress 
 before danger is apprehended. We should, therefore, never trust 
 to nature and time, a patient, in whom considerable difficulty of 
 breathing exists, accompanied by a wheezing, Nor must we be 
 deceived, because the cough is not severe; for, in some of the 
 worst cases, the cough is not always violent. The cough, for the 
 most part, is dry and fatiguing, and comes on by paroxysms. The 
 pulse is hard, for the most part, and always frequent; thirst great; 
 tongue loaded ; bowels constipated, and a hot skin. This is a state 
 of great danger; the bronchia are soon filled with mucus, and the 
 patient dies from the failure of the due oxygenation of the blood. 
 This complaint must be treated as an acute bronchitis. A de- 
 ranged state of the bowels may also follow, particularlyif the 
 disease have been ill managed, by over stimulating, by exposure, 
 or improper diet, too soon after the fever has passed away. On 
 this account, a patient-recovering from this disease, should never 
 be exposed to cold or damp; and should be confined for some 
 time to a milk and vegetable diet, and made to wear, in cold or 
 -cool weather, flannel next to the skin. Sydenham informs us, 
 that the diarrhoea following measles has always been best relieved 
 by blood-letting.* 
 
 * There is a curious circumstance mentioned by Dr. Tourtual, a Dutch physi- 
 cian, which, if proved to be a fact, will be highly interesting- in the history and 
 treatment of measles. He states, that at a period when measles were epidemic, 
 
OF NETTLE RASH. 515 
 
 CHAPTER XXXVI. 
 
 OF URTICARIA, OR NETTLE RASH. 
 
 1726. This very troublesome, and oftentimes obstinate com- 
 plaint, is wont to attack children who are teething, or who in- 
 dulge much in ascescent food, or fruits, in the summer season 
 especially. Dr. Good defines the idiopathic species to be — " Rash 
 in florid, itching, nettle-sting wheals; appearing about the second 
 day; irregularly fading and reviving, or wandering from part to 
 part; fever, a mild remittent." Vol. II. p. 384. 
 
 1727. This definition may be correct in what Dr. Good calls 
 the idiopathic form of urticaria; but there are some remarkable 
 deviations from it. We have seen many instances of this com- 
 plaint come on very suddenly, when certain substances have been 
 taken into the stomach, and which was only relieved by such 
 substances being again discharged from it. We know a gentle- 
 man in whom this complaint has been several times produced by 
 eating of very young boiled chicken; (when roasted or broiled, 
 they would not affect him;) by boiled young cabbage in the spring 
 of the year, and by a draught of cold lemonade when the body 
 is over-heated. After either of these substances is received into 
 the stomach a few minutes, he becomes violently sick; will vomit, 
 and in a moment be covered with wheals, which will remain un- 
 til he effectually cleanses his stomach of the offending matter. 
 This affection is rarely idiopathic — at least, we have never seen 
 such a state of the skin; though both Good and Plumbe make 
 the distinction. Mr. Plumbe says, "Notwithstanding the very 
 general origin of urticaria in temporary or accidental disorder of 
 the system, it often occurs as an idiopathic affection, or, in other 
 words, as a consequence merely of extraordinary irritability of 
 the skin; and hence some persons can produce it with slight fric- 
 tion on any part of their body, even where no suspicion of the 
 
 all the children who were under treatment with sulphur for the itch, escaped the 
 disease; and that those who were taking sulphur for the hooping-cough enjoyed 
 the same immunity. Also, he says, that many children who were taking a mix- 
 ture of sulphur and camphor, and to whom these medicaments were applied by 
 frictions, were not attacked by measles, while those who were not subjected to 
 this medicine were affected." Amer. Jour, of Med. Scien. for May, 183:2. 
 
 * 
 
516 OF NETTLE RASH". 
 
 slightest derangement of the function of any organ can be ascer- 
 tained." — Practical Treatise on the Diseases of the Skin, p. 272.* 
 
 1728. Dr. Hewson mentions several cases of eruptions which 
 arose from taking of balsam copaiva: some resembled the wheals 
 of urticaria, others, erythema, or roseola. Strawberries some- 
 times give rise to urticaria; we know a lady who never fails to 
 have it after eating of this fruit. 
 
 1729. This is a very troublesome complaint, in consequence of 
 the excessive itching which always attends it. It is almost al- 
 ways accompanied by sickness of stomach, headach, giddiness r 
 and great susceptibility to become chilly, upon the slightest ex- 
 posure of any portion of the body. The fever which attends 
 may be of greater or less violence, but almost always observing 
 an evening exacerbation ; at which time, all the symptoms are 
 increased, and especially the itching, The wheals w 7 hich ap- 
 pear upon the skin are sometimes very extensively spread over 
 tire body; ancTat others, confined to certain portions of it, espe- 
 cially upon the inner surface of the fore arms, and inside of the 
 thighs. 
 
 1730. From the surface of the wheals there issues an acrid 
 serum, or lymph, which serves to perpetuate, or renew the trou- 
 blesome itching; and such is the disposition of the skin, while la- 
 bouring under this affection, that you may at pleasure, if the fe- 
 ver be considerable, produce a continual eruption, by drawing 
 the nail forcibly over the skin, at almost any portion of it. 
 
 1731. This eruption sometimes disappears as suddenly as it 
 had showed itself; and when this is the case, serious consequences 
 have sometimes resulted, though this disease is but very rarely 
 fatal. We but once have witnessed danger from the retroces- 
 sion of the eruption. In this case, the patient had had previous- 
 ly several attacks of an intermittent, from which she had been 
 relieved each time by the sulphate of quinine. Her health ap- 
 peared to be rapidly mending for some time, and she had nearly 
 acquired her wonted strength; when very early one morning 
 she was attacked with urticaria, to which she had been occa- 
 sionally liable. 
 
 1732. Soon after it had made its appearance, she became ex- 
 
 * Mr. Plumbe says, that a fluid readily escapes, if these wheals be punctured? 
 by a sharp instrument, (p. 272.) 
 
OF NETTLE RASH. 5lT 
 
 tremely sick, and vomited very freely : she complained of a se- 
 vere pain in the head, which was quickly followed by delirum. 
 At this time we saw her: besides the symptoms just named, 
 we found her extremely restless, throwing herself into a variety 
 of positions, as if unable to keep quiet for a moment. The face 
 was cadaverous, and evinced much uneasiness; her intellect was 
 not sufficiently collected to give us any rational answer to our 
 questions. The extremities were cold, the pulse nearly extinct, 
 and the breathing very laborous — in a word, her situation was 
 truly alarming. 
 
 1733. Hot applications were made to the feet and legs; a 
 very large sinapism was applied to the region of the stomach; 
 and ten grains of the carbonate of ammonia were ordered^every 
 hour, together with a spoonful of hot brandy toddy every few 
 minutes. 
 
 1734. The parts of the body from which the eruption had 
 disappeared, exhibited a mottled livid hue; other portions of the 
 skin w r ere " goose-fleshed," to a great degree. The bowels were 
 spontaneously opened, at the time the puking took place, and 
 she passed a large quantity of urine. 
 
 1735. We saw our patient after an interval of two hours, and 
 found her in rather a more favourable situation, but very far 
 from being relieved. The legs and feet were a little warmer, 
 but the mustard had scarcely acted upon the skin. The volatile- 
 alkali and brandy toddy sat well on her stomach; the delirum 
 somewhat abated, and the whole skin looked more natural. The 
 remedies were ordered to be continued. 
 
 1736. At the end of two more hours, we again visited our 
 patient; 'and now found her much amended — that is, the 
 warmth of the body greater, and more natural ; the delirum r 
 and jactitation, less; the pulse more open ; the countenance more- 
 natural, and less distressed, but no return of the eruption. Re- 
 medies were ordered to be continued. 
 
 1737. In the evening, upon our return, we found a pretty 
 plentiful crop of the eruptive wheals attended by much itching. 
 The warmth of the skin rather above the natural standard; the 
 delirium gone; the inquietude over. The volatile alkali and 
 brandy were suspended; a liberal dose of magnesia ordered; 
 and a little chicken water, from time to time was allowed. 
 
 ♦ 173S. On our visit on the following morning, we found our 
 
518 OF NETTLE RASH. 
 
 patient feeble, but relieved from the eruption, and free from 
 fever. She was soon restored to health.* 
 
 1739. It would be difficult to say, what may be the cause of 
 idiopathic urticaria: be this what it may, the force of the disease 
 is chieny spent upon the cutaneous system; but with which the 
 stomach is sure to sympathize; or the stomach may be the seat 
 of the affection, and the skin sympathize with it. It sometimes 
 becomes chronic; and we have known several young people 
 liable several times in the year to returns of it, without any. 
 evident exciting cause. 
 
 1740. This disease, however, is much more frequently a sym- 
 pathetic affection, and arising sometimes from difficult dentition, 
 and at other times from some offensive substance taken into the 
 stomach; this is especially the case -with children, until the age 
 of puberty. Acids of every kind seem capable of producing 
 it — hence, the frequency.of its appearance after crude fruit, cu- 
 cumbers, young cabbage, lemonade when the body is heated, &c. 
 
 1,741. The plan of treating this complaint is in conformity to 
 the condition of the stomach; for whether this disease be idio- 
 pathic or symptomatic, the stomach is sure to possess great aci- 
 dity — to destroy this, is essential both to its alleviation and cure. 
 Magnesia should, therefore, be freely prescribed; lime-water 
 and milk should also be given, particularly when the eruption 
 has continued several days. A milk diet should be adhered to; 
 and if no fever be present, chicken water and beef tea may be 
 indulged in. 
 
 1742. It is common in this disease to give saline purges; but 
 this is decidedly injurious — there is no purgative so certain or 
 proper as magnesia, or magnesia and rhubarb. It is also com- 
 mon to permit the patient to take lemonade; but this is still 
 worse — plain water, or toast water not too cold, are the best 
 drinks. Solid food should be avoided, as should damp places, 
 or streams of cold air. 
 
 1743. To relieve the excessive itching, the patient should be 
 liberally dusted with well toasted rye or wheat flour, and resist 
 as much as possible the desire of scratching; instead of which, 
 
 * Though professedly treating of the diseases of children, we thought the 
 case just related might not be uninteresting, notwithstanding it occurred in an 
 adult. 
 
OP BURNS. 519 
 
 let the part be well rubbed with a handful of flour, and much 
 relief will be experienced. 
 
 1744. In the chronic form of this complaint, we have found a 
 persevering use of small doses of Fowler's mineral solution, to 
 have succeeded in every case in which we have hitherto tried it. 
 
 1745. A very interesting case of chronic urticaria is related 
 by Cazenave. " In the Hospital of St. Louis, in a patient of Mr. 
 Biett's wards, we have seen it accompanying a quotidian inter- 
 mitting fever, and after having lasted for four years, finally in- 
 duce swellings and great distention, ecchymoses, ruptures, and ul- 
 cerations. In many paroxysms it was accompanied with a gene- 
 raj tumefaction, sometimes to such a degree that the patient was 
 nearly suffocated; his respiration was hurried, the movement of 
 the thorax very slight, the neck swelled, the face puffed up and 
 of a violet colour, the pulsations of the heart intermitting, and, 
 at times, scarcely perceptible; and death, which appeared immi- 
 nent, only prevented by large bleedings. This patient, who had 
 passed through several hospitals, and in which every means of 
 cure had failed, w T as at last restored to health by the use of Fow- 
 ler's solution."* 
 
 1746. We believe we were the first to recommend Fowler's 
 solution, for the cure of chronic urticaria. Children of from 
 seven to'fourteen years old, may take four drops every morning, 
 noon and evening, in sugar and water; or, should this sicken, 
 give but three. 
 
 CHAPTER XXXVII. 
 OF BURNS. 
 
 1747. Accidents from fire, or hot water, are so frequent and 
 ■so sudden in their occurrence, and so dangerous, oftentimes, in 
 their consequences, that it becomes important that almost every 
 one should have a knowledge of the modes of treating them. 
 
 174S. The extent of such accidents must necessarily be vari- 
 ous; consequently, all cases of burns need not be treated pre* 
 cisely in the same manner. A burn may consist simply of in- 
 flammation; or it may be accompanied by vesications; or the 
 mischief may be still greater, and the part may be killed. 
 
 • Pract. Syn. of Cut. Dis. Trans, p. 65, 
 
520 OF BURNS. 
 
 1749. The great anxiety when this accident happens, is to 
 know what should first be applied. Authors differ widely in 
 their opinions upon this point; and opposite remedies in their 
 turn are proposed, and had recourse to. We shall not enter into 
 the disputes upon these points, but shall simply relate what we 
 ourselves have found to answer best; and only name some of the 
 other. remedies, of which we have no experience. 
 
 1750. When a part is merely inflamed, we have found the 
 steady application of cold whisky, brandy, alcohol, and even 
 water, not only relieve the immediate pain, but sometimes to 
 quickly remove the inflammation, especially if it be not exten- 
 sive. If the inflamed portion of skin be considerable, the same 
 plan may be pursued; but the relief will not be so sudden, though 
 it may, eventually, be as certain. Wrapping the part in cotton 
 is highly recommended, but we cannot speak of it from expe- 
 rience. 
 
 1751. If vesications attend, we almost always apply the spirit 
 •of turpentine a little warmed to the part, and protect it from the 
 air as quickly as possible, if the wound be considerable; and, 
 also, that the turpentine should not be applied to the sound skin. 
 Should much pain attend, we give a suitable dose of laudanum. 
 We almost always allow the first dressings to remain for twelve 
 hours; and when we re-open the sore, we take care it shall not 
 be exposed to a current of air, or a cold atmosphere. Our se- 
 cond dressing consists of the basilicon ointment, according to 
 the recommendation of the late Dr. Physick. 
 
 1752. We are in the constant habit of opening the vesications 
 by the point of a needle, before we apply the ointment. This 
 kind of dressing is continued as long as the peculiar inflamma- 
 tion of a burn continues; or, as the common people express it, 
 until the fire is out. Should the discharge now become too abun- 
 dant, (a very common occurrence, especially if the surface be 
 large,) we use the cerate of Turner, or the simple cerate, in 
 which a quantity of prepared chalk is incorporated. 
 
 J.753. Should the burn be deep, and of course the part killed, 
 the basilicon is the best application until the parts begin to show 
 . signs of separation. But should the parts immediately round the 
 injured part be much inflamed, we are in the constant habit of 
 using the bread and milk poultice, until it subside. When the 
 inflammation is reduced to a healthy degree, we return to the 
 basilicon, or to the cerate, until the part slough out. After this 
 
OP BURNS. 521 
 
 has taken place, we either use Turner's cerate, or the basilicon, 
 or simple cerate, as the wound may seem to require. We use 
 the first where the discharge is too abundant; the second, where 
 it is deficient; and the third, where the suppurating process is 
 going on kindly. 
 
 1754. In extensive burns, the patient almost always com- 
 plains of a sensation of cold. When this is the case, a free dose 
 of laudanum should be given, and he should be placed in an at- 
 mosphere of a moderate temperature. The wound should be 
 opened only when necessary. Should much reaction take place, 
 all stimulating substances, as liquor, animal food, or broths, 
 should be withheld; and in some few instances, even bleeding 
 and purging are necessary. 
 
 1755. The consequences to be apprehended, or, in other 
 words, the prognosis of burns, are sometimes extremely difficult 
 to pronounce — for they do not always endanger in proportion 
 to their extent, yet they do so as a general rule.* We once saw 
 death in a very few hours, follow a scald over the region of the 
 stomach. The wound was not more than four inches square; 
 the whole of the cuticle was removed in taking off the clothes. 
 The child made no complaint; on the contrary, it soon fell into 
 a sleep from which it did not properly awake, before it died. 
 A remarkable circumstance attended this wound} it appeared to 
 heal over its whole extent, an hour or two before death.t 
 
 1756. Nor is the pain in proportion to the injured surface ; on 
 the contrary, small burns sometimes give more pain than large 
 ones; owing, doubtless, to the more or less destruction of the 
 vital principle in the parts affected. My friend, the late Dr. Phy- 
 sick and myself, witnessed a remarkable case of this kind, in a 
 
 * " The unqualified statement that constitutional irritation is in proportion to 
 the extent of surface destroyed, or the depth to which the destroying- agent has 
 penetrated, would be incorrect: such a statement would apply generally, if not 
 universally, after the lapse of three or four days from the injury, or, in other 
 words, to the after stages of the process; but it is unquestionable, that the situa- 
 tion of the injury, is, as regards the first days, of greater importance — burns upon 
 the neck, chest and abdomen, exclusively, proving oftener fatal by direct irrita- 
 tion." — Travers on Constitutional Irritation, p. 76. 
 
 •j- " Where the cutis is charred and killed, the constitutional sympathy is less 
 than where the cuticle, ravelled up into folds like wetted paper, leaves the cutis 
 bare? and for similar reason, vesications, however large or numerous, excite less 
 irritation than the state last mentioned." — Ibid, p. 76. 
 
 66 
 
522 OP BURNS. 
 
 young lad, who had fallen up to his chin into a soap-boiler's cal- 
 dron. He was quickly taken out, but complained of no pain 
 whatever. He died in a few hours after the accident. 
 
 •1757. When burns-become extremely painful soon after they 
 are inflicted, we believe nothing affords such immediate relief as 
 cold. This may be applied by means of a bladder nearly filled 
 with water, and laid upon the part — it is sometimes useful to add 
 ice to it; or ice may be applied over the dressings, agreeably to 
 the recommendation of Sir James Earle.* 
 
 1758. Burns have almost always this peculiarity in healing; 
 namely, they most rapidly shoot up fungus; nor is this easy to 
 subdue, even by active caustics, which we are almost always 
 obliged to use. There is little or no sensibility in this fungus: 
 when it is abundant, we have often applied caustic to such sur- 
 faces, without the patient expressing the least uneasiness. When 
 it is more moderate in quantity, it is generally more sensible. 
 
 1759. It may.be proper to mention, that we have seen great 
 error committed in the application of caustic, by its being spread 
 over the whole fungous surface. This, we believe, is never ne- 
 cessary; for the healing proceeds pretty constantly from the 
 margins of the wound; consequently, it is only necessary to sup- 
 press its excess immediately at the edges. Dry lint, where com- 
 pression can be easily made, is very useful in removing this su- 
 perabundant product. But the lunar caustic is the least irri- 
 tating, and most certain of all the escharotics we have employed, 
 if we except the burnt alum. In a case where a large exposed 
 surface was filled with a feeble jelly-like fungus, we sifted over 
 its whole extent the burnt alum almost daily, with the most 
 marked and prompt advantage. This application did not appear 
 to give the slightest pain, though we had anticipated a very dif- 
 ferent result. 
 
 1760. When burns are healing, great pains should be taken 
 that no two parts that are naturally separate, should come in 
 contact, lest they adhere permanently. On this account, when 
 the hands or feet are the seats of the accident, the fingers and 
 toes should be kept separate, by well-regulated dressings. 
 Splints and bandages may also be necessary to prevent coales- 
 cence, or contractions. 
 
 * See American Journal of Medical Sciences, for August 1833, for Mr. Holt's 
 account of the use of Chloride of Soda, in burns, scalds, and black eyes. 
 
OP PROLAPSUS ANT. 523 
 
 CHAPTER XXXVIIL 
 OF PROLAPSUS ANI. 
 
 1761. This is a very troublesome complaint, where the habit 
 of descending is of long standing. It always excites a great 
 deal of solicitude for the event, though the disorder cannot be 
 considered as dangerous. 
 
 1762. As the inner coat of the rectum is looser, and longer 
 than the external, it is frequently made to descend, by whatever 
 will excite a straining, or tenesmus — hence, the frequency of 
 this accident after bowel complaints, especially dysentery. The 
 worms called ascarides; (1634) a stone in the bladder; over 
 purging; long-continued costiveness, &c, will, sometimes, pro- 
 duce this complaint.^ 
 
 1763. It will descend to various lengths; from half an inch 
 to several inches; and will very often, in the recent state of the 
 disease, return of itself, for a time. But this is of but short du- 
 ration; for repeated descents for a few days will generally 
 confirm the complaint, and its falling will soon become habitual. 
 When it is down, the child suffers considerable pain, especially 
 if it be not soon returned; as the sphincter ani acts as a kind of 
 ligature upon the prolapsed gut. If thus constricted, it soon 
 swells, and inflames; and sometimes the stricture is so con- 
 firmed, as to prevent a free return of the venal blood of the 
 part; in consequence of which, it soon becomes livid, or even 
 black, and assumes an appearance really menacing. 
 
 1764. To prevent this, care should be taken that the gut be 
 returned as quickly after its descent as may be possible; espe- 
 cially where it is from time to time threatened with this kind of 
 strangulation. To ensure the return of the gut, after it has pro- 
 lapsed, as soon as practicable, the mother should be instructed 
 in the method of reducing it, that no time may be unnecessarily 
 lost after its escape. The method of doing this is extremely 
 simple, and equally easy in recent cases; but in the chronic af- 
 fection, it is sometimes very difficult to accomplish. 
 
I 
 
 524 OF PROLAPSUS ANI. 
 
 1765. For the purpose of reducing the prolapsed bowel, the 
 ■child must be laid across the lap, with its head a little lower than 
 its hips. The part must then be lubricated by sweet oil, or fine 
 hog's lard; a piece of fine linen may be laid over the part; then 
 .commence the attempt at restoring it, by making a gentle, but 
 continued pressure in such direction as shall tend to return the 
 gut within the spincter ani. When you have diminished the 
 distended part, by forcing a portion of blood from it by the 
 pressure made by the fingers, the gut must be urged upward, 
 ,and a little backward, until it retire within the verge of the anus. 
 
 1766. Sometimes this operation succeeds best, by placing the 
 point of the fore-finger against a portion of the prolapsed gut, 
 .and carrying that portion immediately forward, until it pass the 
 sphincter, or the constricting part. After this has passed, ano- 
 ther and another portion is carried in the same manner, until all 
 is restored. This method has never failed with us, when the 
 prolapsed part has not been considerable; but it may not suc- 
 ceed when a large portion is down. In this case, a steady pres- 
 sure, as above directed, (1765) is the only one we know to be 
 useful, for it requires some patience for the pressure so to re- 
 duce the swollen part, that it may repass the sphincter ani. 
 
 1767. Indeed, it sometimes becomes so enlarged by hanging 
 down, that it would be vain to attempt the replacement, until 
 the bulk of the tumour was reduced by proper applications, and 
 management. For this purpose the child should be kept in a 
 horizontal position upon its back, with its knees drawn up, and 
 the hips raised higher than the head. The part itself should 
 remain exposed to the air,* but occasionally moistening it with 
 lead- water of a proper strength ; for on this much depends. t 
 
 1768. Dr. Underwood declares, (Vol. II. p. 54,) that "should 
 such a case occur in children, as it frequently does in adults, in 
 which the bowel may not be easily returned, on account of su- 
 pervening tumour and inflammation, the stricture will never fail 
 
 * If the weather be cold, the child should be protected by a sufficient quan- 
 tity of covering, though the part itself should be left free. 
 
 f The following" formula for the lead-water is the one we are in the habit of 
 employing:— 
 
 5f. Sacch. Saturn. ^i. 
 
 Aq. Font. § v "j« 
 
 f. Sol.— 
 
OP THE WHITLOW. 525 
 
 to yield to an injection of cold water with a few drops of aq. 
 lithargyri acetati,* with five or ten drops of the tine. opii. An 
 hour or two after such injection has been thrown up, the pro- 
 lapsed intestine, though perfectly black as well as swollen, will 
 be found to retire of itself." - 
 
 1769. In cases, however, of prolapsus ani, the great object 
 is to prevent a recurrence of its dropping — for this purpose, the 
 plan of the late Dr. Physick is highly important, as we have 
 more than once tested by experience. He directs, 1st, that the 
 patient should live altogether upon rye mush sweetened with 
 molasses, or brown sugar. By this diet the faeces become very 
 soft, and, of course, can be readily expelled, without much effort 
 of the child for this purpose; consequently, the risk of the gut 
 coming out is diminished. 2dly, That the child should be 
 made to pass its evacuations while standing; by this means the 
 habit of straining is interrupted, and the bowel permitted to re- 
 tain its situation. 
 
 1770. The child should sit upon a hard-bottomed chair with- 
 out arms ; and it should be of such a height, as not to allow the 
 feet to touch the floor. 
 
 1771. It will be proper, however, to observe, that as this af- 
 fection may have a number of causes, any attempt for its relief 
 will be totally useless, until the complaint producing it be re- 
 moved ; therefore, in all such cases as do not depend merely upon 
 habit, attention should be first directed to its remote cause.t 
 
 CHAPTER XXXIX. 
 
 OF THE WHITLOW. 
 
 1772. The extremities of the fingers are liable to a very pain- 
 ful inflammation, termed whitlow; which almost always termi- 
 
 * The following form may be used for this prescription, for a child from three 
 to five years old: — 
 
 £. Sacch. Saturn. gr. v. 
 
 Tinct. Thebaic. gut. x. vel xv. 
 
 Aq. font. frig. gj. 
 
 M. f. enem. 
 f See Amer. Joum. Med. Scien. for August, 1833, p. 530, for Dupuytren's 
 method of treatment. 
 
556 OP THE WHITLOW. 
 
 nates in suppuration. It is commonly divided into four species, 
 which, perhaps, merely differ in degree. 
 
 1773. The first species is the mildest; and locates itself at the 
 side or root of the nail. In this species, the inflammation seems 
 to penetrate no deeper than the true skin ; and when it termi- 
 nates in suppuration, the matter is confined immediately below 
 the cuticle. Should the matter find its way beneath the nail, the 
 patient has to endure a great deal of pain from its confinement 
 in so unyielding a part. 
 
 1774. In the second species, the inflammation penetrates be- 
 low the true skin, near the extremity of the finger. It creates 
 much pain, especially in very young people; it eventually sup- 
 purates; but it requires a good deal of time before the matter 
 discharges itself. 
 
 1775. In the third species, the inflammation is seated within 
 the theca which covers the flexor tendons. When suppuration 
 takes place in this species, the matter finds great difficulty in 
 passing to the surface of the skin, in consequence of which, it is 
 found to pass along the sheaths of tendons, sometimes even to 
 the wrist. 
 
 1776. In the fourth species, the periosteum is the seat of the 
 inflammation ; and even the bone itself sometimes Becomes in- 
 flamed. But in this case, the inflammation and suppuration are 
 more limited than in the last species. 
 
 1777. In both the third and fourth species, the pain is extreme; 
 and the inflammation sometimes runs so high, as to swell both the 
 hand and arm. Much fever is sometimes excited; and we have 
 known even delirium to attend. 
 
 1778. This disease is frequently produced by punctures, or 
 other injuries of the like kind — we have known it several 
 times produced by the sharp fin of a fish; and especially the 
 cat-fish. 
 
 1779. The different species will require something different in 
 the treatment. It rarely fails to suppurate ; and we still more 
 rarely have it in our power to prevent it. Several plans, how- 
 ever, have been proposed for this purpose ; some of which are 
 said to have been attended with success — such as holding the 
 finger in very warm water, vinegar, or lie; poultices of the white 
 of an egg and honey ; of lie ; of brown soap, &c. 
 
 1780. As this complaint almost always runs on to suppuration, 
 
OP THE WHITLOW. 527 
 
 the sooner this is promoted the better; especially in the first 
 two species. For this purpose, we believe there is nothing bet- 
 ter than the good, old fashioned bread and milk poultice. This 
 must be repeated every few hours, until the matter forms. When 
 this happens, it should be discharged, by opening the abscess as 
 soon as it becomes evident. The wound may be dressed with 
 simple cerate. 
 
 1781. In the third and fourth species, much more trouble and 
 pain are experienced. Blisters are said to have relieved this deep- 
 seated inflammation: we believe this has happened, but it has 
 been rarely. Much patience must be exercised, and suffering 
 endured, before the matter in these cases will find its way to the 
 surface; and sometimes much mischief is done the parts below 
 and around it, before this happens. The bone and tendons are 
 killed, and the usefulness of the hand is sometimes destroyed, by 
 permitting this complaint to run its course. M. Serre D'Alais 
 highly exjols the application of mercurial ointment in parenychia. 
 The finger is to be rubbed with it every fifteen minutes, and then 
 enveloped in it by means of a soft rag. — Amer. Jour, of Med. Sci. 
 
 for Nov. 1834. We have tried the plan of cure in a very pain- 
 ful parenychia with decided advantage. 
 
 1782. On this account, it is considered best to cut down to 
 the part, in the direction of the finger, before suppuration has 
 taken place, or as quickly after as possible; and not to wait for 
 the tedious and painful operation of spontaneous opening. By 
 this plan immediate relief is always experienced; for if suppu- 
 ration has not taken place, a wound which will quickly heal is 
 substituted for an untoward inflammation, which would eventu- 
 ally terminate in it. If matter has formed, it will now be dis- 
 charged, and the parts will readily heal, by very common atten- 
 tion — the wound may be poulticed for two or three days after 
 the incision has been made, and then dressed with simple cerate. 
 If the bone or tendon has sustained injury, the progress of the 
 cure will be very slow. Bone may exfoliate, or tendon slough. 
 The portions of the bone should be removed by forceps, when 
 loose, and the protruding tendon cut off, as it may appear. If 
 proud flesh shoot up through the external opening, it must be 
 removed by caustic, or the opening enlarged. 
 
528 OF DISCHARGES FROM THE VAGINA. 
 
 CHAPTER XL. 
 
 OF THE DISCHARGES FROM THE VAGINA. 
 
 1783. We occasionally find, that very young children have a 
 discharge from within the labia, of a thin acrid kind, or of a pu- 
 rulent appearance. When this occurs in very young subjects, 
 it almost always proceeds from a neglect of cleanly attention to 
 these parts ; either by withholding a frequent use of lukewarm 
 water, or permitting the child to remain too long wet. In either 
 case the difficulty is easily removed, by frequent washing, and 
 the occasional use of weak lead-water. (See note to par. 1767. t) 
 
 1784. Children, however, more advanced in age, have also 
 discharges of a purulent character, that seem to arise from a 
 morbid action of the mucous membrane of the vagina or labia. 
 This frequently shows itself about the fifth year, and. may con- 
 tinue, if neglected, to almost any period. Parents, therefore, 
 cannot be too much upon the alert, when this discharge is dis- 
 covered on their children; nor too early in the application of 
 suitable remedies for its removal. It is in a great measure owing 
 to this neglect, that fluor albus, or whites, become so common, 
 and of such difficult management, in adult age. 
 
 1785. If not interrupted in the beginning of its career, it is 
 apt to continue until the period of puberty, over the phenome- 
 na of which, it but too often exerts an unfriendly influence.* 
 
 1786. The cure of this complaint must be attempted, by a 
 strict attention to cleanliness ; having the parts washed three or 
 four times a day with warm water; and each of these washings 
 to be followed by another, of warm lead-water. Should the 
 parts be inflamed, or excoriated, they should be covered from 
 time to time with very fresh lard. If the bowels be costive, 
 small doses of magnesia should be given daily, so as to keep 
 them a little free. Should they not be costive, or inclined to 
 lax, the prepared chalk mixed with magnesia, or alone, accord- 
 ing to either of these states, may be used. The diet should 
 be strictly of milk: rice, or Indian mush, may be taken with 
 the milk, or bread simply, if preferred. 
 
 * Treatise on the Diseases of Females, Chapter on Deranged Menstruation, 
 by the author. 
 
OP SCURFINESS OF T#E HEAD. 529 
 
 1787. Should these fail to interrupt the discharge, we must 
 have recourse to some other remedies. The most certain that 
 we have found, is the tincture of cantharides in proper doses.* 
 But should a prejudice be entertained against it, or if it fail, 
 small doses of the balsam copaiva may be given;! and a plaster 
 of Burgundy pitch should be applied to the back, very low 
 down. But care should be taken, that it is not allowed to re- 
 main long after it excites considerable itching; as it may pro- 
 duce too much irritation. 
 
 CHAPTER XLI. 
 OF SCURFINESS OF THE HEAD. 
 
 178S. Children, within the month, contract a dark-coloured 
 scurf; especially from the top of the forehead to the back part 
 of the head. It usually commences near the anterior fontanelle, 
 or opening of the head, and gradually spreads itself, until it co- 
 vers the whole crown. It acquires a considerable thickness, and 
 will sometimes be thrown off in large flakes, or be frequently 
 removed by rubbing, in consequence of its itching. 
 
 1789. At times this itching is so severe, as very much to inter- 
 rupt the comfort of the child. The scurf is occasionally very 
 offensive; its smell resembling that of sour curd. If the part be 
 closely viewed, it will frequently be found covered with a vast 
 number of small pustules, which, after awhile, pour out a thin 
 acrid lymph; and this becoming dry, forms a crust. Upon the 
 removal of the crust by any kind of violence, the skin under- 
 neath is often found inflamed. The removed crust, however 
 will quickly be replaced, by the exposed surface pouring out a 
 quantity of fresh lymph, which quickly hardens into a new one. 
 
 * It is proper to begin with small doses of this medicine, say, five drops, every 
 morning-, noon, and evening 1 , in a little sugar and water. After this quantity has 
 been taken a few days, the dose may be increased a drop or two; and it may be 
 thus augmented to ten or twelve drops, or even more, if necessary. But if any 
 irritation of bladder show itself, it must be laid aside until it cease. Should it 
 be required after this by a continuation of the discharge, it may be commenced 
 again, and proceeded with, as just mentioned. 
 
 | From eight to ten drops of this balsam may be given three or four times a 
 day. dropped on some brown sugar, and washed down by a little warm milk. 
 
 67 
 
 I 
 
* 
 
 530 OF SCURFIjNESS OF THE HEAD. 
 
 1790. The formation of this crust, is, for the most part, owing 
 to neglect, and this neglect arises from prejudice; it being sup- 
 posed by many, that it would be wrong to remove it; and thus 
 it is permitted to accumulate, in unsightly and injurious quanti- 
 ties. 
 
 1791. As this complaint (if it may be so termed in its com- 
 mencement) originates from a neglect of cleanliness, it should be 
 removed after it has occurred, by suitable means; or be prevent- 
 ed by proper precautions. If.it be neglected, this now inoffensive 
 scurf may degenerate into a real disease, and require time for its 
 removal. The proper plan of management, will consist, 1st, in 
 its prevention; and, 2dly, in its cure after it has taken place. 
 
 1792. 1st, To prevent this, all that is necessary is to have the 
 head of the child regularly washed every morning with water, 
 or with a little line soap and water; to have it well wiped and 
 dried with a fine cloth ; and then brushed with a brush of suffi- 
 cient stiffness to penetrate to the skin; and not to have the caps 
 of the child of a too thick material. 
 
 1793. 2dly, After the incrustation is formed, it should be 
 rubbed with sweet oil, or fine lard, at night, and washed off with 
 a strong solution of borax and water — that is, in the proportion 
 of an ounce of the borax to three half pints of boiling water. 
 
 1794. The borax water should be a little warmed, before the 
 head is washed with it; and this repeated daily, until the scurf is* 
 removed.* After the scurf is removed, the-part should be washed 
 daily for a few days with the solution of borax, which will ef- 
 fectually prevent its re-formation. 
 
 1795.' Should, however, the skin beneath the scurf be inflamed, 
 or yield a purulent discharge, the parts should be rubbed once 
 a day with the tar ointment, having first prepared the parts by 
 washing, &c, as just directed. 
 
 1796. We have seen this scurf attempted to be removed, by 
 simply washing and combing the head. We do not approve of 
 this plan ; as the fine comb, which is always employed, fre- 
 quently produces so much irritation, as to increase the disease, 
 A brush is the most proper instrument for this purpose, as just 
 suggested, 
 
A TRANSLATION 
 
 THE PRESCRIPTIONS., 
 
 * 
 
 Page 292, par. 943. 
 Take, Of prepared calomel, 3 grains. 
 
 Loaf sugar, 6 grains. 
 
 Mix intimately, and divide into 1& parts. 
 
 Page 299, par. 975. 
 Take, Prepared chalk, 2 drams. 
 
 Laudanum, 20 drops. 
 
 Oil of caraway, 1 drop. 
 
 White sugar, 2 drams. 
 
 Water, 1 ounce. 
 
 i Mix. 
 
 Page 308, par. 1004. 
 
 Take, Calcined magnesia, 12 grains. 
 
 Laudanum, 3 drops. 
 
 Loaf sugar, enough to make sweet. 
 
 Water, 1 ounce. 
 
 Mix. / 
 
 Page 311, par. 1013. 
 
 Take ; Calcined magnesia, 20 grains. 
 
 Tincture of asafoetida, GO drops. 
 
 Laudanum, 20 drops. 
 
 • Water, 1 ounce. 
 
 - — Mix. 
 
 Page 313, note to par. 1016. 
 Take, Sulphate of quinine, 1| grain. 
 
 Loaf sugar, l£ dram. 
 
 Water, 1 ounce. 
 
 Dissolve^ 
 
 Page 31T, par. 1032. 
 
 Take, Prepared calomel, 4 grains. 
 
 Calcined magnesia, 8 grains. 
 
 Mix, and divide into 8 parts. 
 
532 TRANSLATION OF THE PRESCRIPTIONS. 
 
 Page 318, par. 1034. 
 Take, Acetate of zinc, 2 grains. 
 
 Rose water, 2 ounces. 
 
 Dissolve. 
 
 Page 319, par. 1039. 
 
 Take, Blue vitriol, 10 grains. 
 
 Powdered (best) Peruvian £ 6Q grainSj w , dram 
 
 Gum Arabic, ditto. 
 
 Honey, 2 drams. 
 
 Water, 3 ounces. 
 
 Dissolve, and mix. 
 
 Page 336, par. 1108. 
 Take, Prepared calomel, 10 grains. 
 
 chalk, 20 grains. 
 
 Mix, and divide into 20 parts. 
 
 Page 336, note to par. 1110. 
 Take, Prepared calomel, 2 drams. 
 
 Essence of lemon, 20 drops. 
 
 Common cerate, 1 ounce. 
 
 Mix. 
 
 Page 408, par. 1378. 
 Take, Prepared chalk, 3 drams. 
 
 Laudanum, 20 to 30 drops. 
 
 Oil of cinnamon, 1 drop. 
 
 White sugar, 2 drams. 
 
 Water, 2 ounces. 
 
 Mix. 
 
 Page 413, par. 1398. 
 
 Take, Prepared calomel, 3 grains. 
 
 chalk, 20 grains. 
 
 Opium, half a grain. 
 
 Mix, and divide into 12 parts. 
 
 Page 424, par. 1433. 
 Take, Prepared chalk, or oyster-shells, 1 dram and a half. 
 
 Powdered gum Arabic and loaf? h x d * 
 
 sugar, 5 
 
 Laudanum, 10 drops. 
 
 Water, 3 ounces. 
 
 Mix. 
 
 Same page and par. 
 
 Take, Salt of tartar, or soda, SO grains. 
 
 Gum Arabic and loaf sugar, each 1 dram. 
 
 Tincture of opium, or laudanum, 10 drops. 
 Water, 3 ounces. 
 
 Mix, 
 
TRANSLATION" OF THE PRESCRIPTIONS. 533 
 
 Page 425, par. 1437. 
 
 Take, Copperas 2 grains. 
 
 Oil of vitriol, 10 drops. 
 
 Sugar, 1 dram. 
 
 Water, 1 ounce. 
 
 Mix. 
 
 Page 446, note to par. 1503. 
 
 Take, Tartar emetic, 1^ dram. 
 
 Oil of lavender, or essence of lemon, 15 drops. 
 Simple cerate, 1 ounce. 
 
 Mix. 
 
 Page 524, note to par. 1767. 
 
 Take, Sugar of lead, 1 scruple. 
 
 Water, (soft,) 8 ounces. 
 
 Make a solution. 
 
 Page 525, note to par* 1768. 
 
 Take, Sugar of lead, 5 grains. 
 
 Laudanum, - from 10 to 15 drops. 
 
 Cold water, 1 ounce. 
 
 Mix for an injection. 
 
CJIiOSSAHY. 
 
 EXPLAINING THE TECHNICAL TERMS USED. 
 
 Abscess, a collection of pus. or matter. 
 
 Abdomen, the belly or paunch. 
 
 Abdominal viscera, the contents of the abdomen. 
 
 Abortion, miscarriage. 
 
 Anthelmintics, medicines against worms. 
 
 Antiphlogistic, such medicines as reduce an inflammatory habit. 
 
 Aphthae, baby's sore mouth. , 
 
 Artery, a strong elastic circular tube, which carries the blood from" 
 
 the heart. 
 Axillary, belonging to the arm-pit. 
 
 Cardia, the upper, or left orifice of the stomach. 
 
 Catamenia, the monthly discharge of women. 
 
 Chyle, a white fluid produced by digestion. 
 
 Chyme, the first product of digestion, and from which the chyle is 
 
 separated. 
 Clavicle, the collar bone. 
 Coagulum, a clot of blood, or of milk. 
 Colostrum, the first milk after delivery. 
 Colyrium, a wash for the eyes. 
 Combustion, burning. 
 Congenital, made or formed at birth. 
 Connate, born with. 
 
 Diaphragrii, a muscle which separates the belly from the chest. 
 
 Dorsal, belonging to the back. 
 
 Duodenum, the first bowel below the stomach. 
 
 Dyspepsia, depraved digestion. 
 
 Enema, or plur. Enemata, injection, or injections. 
 Excitability, the capacity to be acted upon by stimuli. 
 Excitement, the action produced by the application of stimuli. 
 Exfoliate, the act of casting off dead bone, or scales. 
 
 Farinaceous, mealy. ^ 
 
 Foetal, belonging to a fetus. 
 Foetus, a young animal before birth. 
 
GLOSSARY, 535 
 
 Gangrene, a mortification, or nearly the loss of life of a part. 
 
 Idiopathic, an original affection of a part. 
 Iliac Passion, dry belly-ache. 
 
 Leucorrhcea, the whites. 
 
 Liquor JLmnii, the water surrounding the fetus. 
 
 Lumbar, belonging to the loins. 
 
 Meconium, the forces of a foetus. 
 
 Miasm, sing. Miasmata, plur., any fume or effluvia capable of pro- 
 ducing disease. \ * 
 
 Nausea^ sickness at stomach. 
 
 Nitrogen, one of the constituents of the atmospheric air. 
 
 • 
 (Esophagus, {he gullet. 
 Ophthalmia, an inflammation of the eves, 
 Ovum, an egg. 
 
 Oxygen, the basis of vital air. 
 Oxygenation, acquiring oxygen. 
 
 Pabulum, food. 
 
 Papula, a very small and accumulated elevation of the cuticle, with 
 an inflamed base, very seldom containing a fluid, or suppurating,, 
 and commonly terminating in scurf. 
 
 Pectoral, belonging to the breast. 
 
 Physical, that which relates to natural agents — that which is opposed 
 to moral. 
 
 Physiology, the doctrine which teaches the use and actions of living 
 parts. % 
 
 Placenta, the after-birth. 
 
 Plethora, fulness of blood. 
 
 Pus, the matter found in abscesses, and other parts after inflamma- 
 tion. 
 
 Pustule, an elevation of the cuticle, with an inflamed base contain- 
 ing pus. 
 
 Pickets, a disease of the bones. 
 
 Rupture, a protrusion of any of the contents of the belly through the 
 parietes of that cavity. 
 
 Sanguiferous system, the blood vessels, both arteries and veins. 
 
 Scab, a hard substance, covering superficial ulcerations, and formed 
 by a concretion of the fluid discharged from them. 
 
 Scirrhus, a tumour affecting glands. 
 
 Scrotum, the bag under the. penis containing the testicles. 
 
 Scurf, small exfoliations of the cuticle, which occur after slight in- 
 flammation of the skin, a new cuticle being formed underneath 
 during the exfoliation. 
 
 Serrrfioh, the separation of. various fluids, and other matters, by 
 r ,;lati<K \\<nn {he blood- 
 
 # 
 
536 GLOSSARY. 
 
 Stigma, a minute red speck in the skin, without any elevation of the 
 
 skin. 
 Symptomatic, arising from, or indicative of, some other affection. 
 
 Tenesmus, an ineffectual urging to go to stool. 
 Tormina, a griping pain. 
 
 Tubercle, a small, hard, superficial tumour, circumscribed and per- 
 manent, or suppurating partially. 
 
 Umbilicus, the navel. 
 
 Umbilical cord, the cord connecting the child with the mother. 
 
 Umbilical hernia, a protrusion of a bowel at the navel. 
 
 Uterus, the womb. # 
 
 Utero- gestation, the term of pregnancy. 
 
 Vesicate, to blister. 
 
 Vesication, blistering. 
 
 Vesicle, a small orbicular elevation of the cuticle, containing lymph, 
 
 which is sometimes clear and colourless, but often opaque, and 
 
 whitish or pearl-coloured. 
 
 Wheal, a rounded or longitudinal elevation of the cuticle, with a white 
 summit, but not permanent^ not containing a fluid, nor tending 
 to suppuration. 
 
INDEX. 
 
 HJ= The first numbers refer to the paragraph, and the latter to the page at which the subject 
 
 commences. 
 
 A. 
 
 Abortion, cause of the facility with which it may be pro 
 cured .... 
 
 physical evils resulting from 
 
 moral obligations to the prevention of . 
 
 dreadful consequences from repeated 
 
 rules to be observed for prevention of . 
 
 produced by a gossip's story 
 
 general rules for the prevention of ' . 
 Appetite, not to be indulged during pregnancy 
 Air, of the ..... 
 
 general observations on 
 
 importance of pure air to children 
 Arguments against the opinion that the imagination has 
 
 power to mark the child in utero 
 Appeal to the good sense of parturient women 
 Absurd modes of dressing young children 
 Accidental and partial application of cold to be avoided 
 Aphthse, or sore mouth of children . 
 
 symptoms ..... 
 
 whether the aphthse pervade the whole alimentary 
 canal . . 
 
 whether contagious or epidemic 
 
 time of life subject to it . 
 
 treatment .... 
 
 B. 
 
 Beauty in females, cause of early loss of . 
 Bleeding not to be used without advice of physician 
 Dr. Struve's opinion on 
 of great importance under judicious direction 
 Buchan's errors in relation to children's dress 
 Belly-band, necessity and utility of 
 
 reasons why it should not be too tight 
 Bathing and cleanliness, general observations on 
 cold bath, definition of, and objections to . 
 warm and tepid bath .... 
 neither warm nor cold bath to be used without the 
 
 advice of a physician 
 Dr. Struve's rules for bathing young children 
 Breasts, inflammation and swelling of, in new-born children 
 erroneous opinion respecting 
 treatment of 
 Burns ..... 
 
 treatment where the skin is merely inflamed 
 where vesications attend . 
 when healing . 
 caution lest adhesion take place 
 
 68 
 
 Par. 
 
 27 
 28 
 29 
 30 
 33 
 88 
 292 
 42 
 
 418 
 445 
 
 68 
 118 
 194 
 236 
 
 983 
 
 986 
 
 991 
 
 1001 
 
 1004 
 
 7 
 
 36 
 
 38 
 
 40 
 
 201 
 
 217 
 
 223 
 
 812 
 814 
 
 826 
 
 827 
 
 1044 
 1046 
 
 1750 
 1751 
 1759 
 1760 
 
 Page. 
 
 25 
 
 26 
 
 26 
 
 26 
 
 27 
 
 44 
 
 102 
 
 30 
 
 126 
 
 126 
 
 135 
 
 38 
 51 
 
 74 
 
 85 
 
 302 
 
 302 
 
 304 
 305 
 307 
 307 
 
 19 
 
 28 
 
 28 
 
 29 
 
 76 
 
 81 
 
 82 
 
 240 
 
 244 
 
 244 
 
 247 
 
 247 
 321 
 321 
 321 
 519 
 520 
 520 
 522 
 522 
 
538 
 
 INDEX. 
 
 C. 
 
 Consequences of ill-assorted marriages 
 Constitution, the best, how perpetuated 
 Constitution, of the 
 
 soundness of, to be considered in marriage contract 
 fallacious appearance relative to soundness of 
 Conduct to be observed before and during delivery 
 during the month .... 
 Child-bi: th rarely dangerous in this eountry . 
 Children always to be suckled by their mothers . 
 
 lives may be endangered by selfish nurses 
 Child, rules for washing the 
 
 general dress, observations on . 
 to be changed whenever circumstances render it ne 
 cessary ..... 
 
 Children new-born and older, physical treatment of 
 Crying of infants ..... 
 Cause of child crying at birth 
 to a degree salutary 
 causes of . 
 Cleanliness and bathing of children . 
 Colic of infants 
 
 divided into two species 
 treatment of each . 
 Constipation . . ... 
 
 oftentimes produced by laudanum 
 treatment of . / 
 
 Cholera infantum . . / 
 
 exciting causes 
 symptoms . 
 prognosis . . 
 
 seat and nature of', 
 treatment / 
 
 in very^oung children 
 regimen during 
 removal to country 
 prevention, modes for the 
 Cynanche tonsillaris, or sore throat 
 symptoms of 
 treatment of . 
 prevention of 
 parotidae, or mumps 
 symptoms of 
 treatment of . 
 trachealis, or croup 
 
 age subject to its attacks 
 mode of attack, and time . J 
 
 most dangerous when neglected in forming stage 
 Laennec's opinion of its character | 
 its anatomical character, by Laennec, (note f) 
 divided into three stages . 
 first stage, or incipient . 
 second, or when the disease is formed 
 third, or congestive stage 
 formation of false membrane 
 •treatment of first stage 
 
 second stage 
 third stage 
 his account of the false membrane 
 his successful remedies, (note *) 
 
 Par. 
 
 9 
 10 
 
 12 
 13 
 91 
 
 112 
 182 
 167 
 
 226 
 
 245 
 
 405 
 
 402 
 405 
 406 
 
 1010 
 1012 
 
 1223 
 1225 
 
 1403 
 1404 
 1412 
 1415 
 1418 
 1422 
 1440 
 1441 
 1443 
 
 1507 
 1517 
 1524 
 
 •1526 
 
 1528 
 
 1537 
 1540 
 1547 
 1549 
 
 1551 
 
 1563 
 
 1564 
 1607 
 
INDEX. 
 
 539 
 
 D. 
 
 Disease, predisposition to . 
 
 dispositions, diseased, do not appear till long after 
 birth . . . . 
 
 hereditary, dishonesty of concealing . 
 Diseases produced by repelled milk 
 
 how removed .... 
 
 Drinks, stimulating-, very injurious 
 
 never used with impunity 
 Diet of mother during the month, general rules for 
 Diapers always to be changed when wet, &c. 
 Dress of the child .... 
 
 how to be regulated to avoid the use of pins 
 
 within the month, general rules for 
 
 from weaning until puberty 
 
 form of garments .... 
 
 quantity and quality of clothing 
 Duties, social, best accomplished when the body is healthy 
 and 'full grown .... 
 
 of the mother after the month 
 mother should learn to wash and dress infant 
 food proper for mother, and rules as to diet 
 danger of •attempting to remedy partial diminution 
 of milk .... 
 
 failure of milk more frequently from an oyer than 
 
 under quantity of food . 
 remedies contributing to improvement of the milk 
 Diseases of children. Book 2 
 Dentition ...... 
 
 gives rise to a variety of sympathetic affections 
 states of the system when attended with danger 
 morbid sympathies connected with 
 symptoms attendant on 
 lancing the gums, directions for 
 co-operative treatment 
 
 advantages arising from cutting the gum, &c. 
 diseases arising from . 
 
 eruptions .... 
 
 crusta lactea, or milky scall 
 tooth rashes 
 
 strophulus confertus. Tooth rash 
 intertinctus. Red gum 
 albidus. White gum 
 volaticus 
 candid us 
 sore ears 
 Diabetes of children . ... 
 
 Diarrhoea of children 
 
 feculent . . 
 
 bilious .... 
 
 mucous .... 
 
 chylous .... 
 
 lienteric .... 
 
 other varieties 
 
 chronic form .... 
 
 treatment of chronic diarrhoea, or weaning brash 
 
 E. 
 
 Evils of precocious marriages 
 Europe, dread of hereditarv diseases in 
 
 68* 
 
 Par. 
 
 14 
 
 15 
 144 
 147 
 
 80 
 83 
 311 
 236 
 193 
 239 
 330 
 
 11 
 
 274 
 
 277 
 
 280 
 
 281 
 290 
 
 1049 
 1055 
 1059 
 1063 
 1068 
 1070 
 1075 
 
 1330 
 
 Page, 
 22 
 
 22 
 
 22 
 
 59 
 
 60 
 
 42 
 
 43 
 
 104 
 
 85 
 
 73 
 
 86 
 
 106 
 
 249 
 
 250 
 
 251 
 
 20 
 96 
 97 
 97 
 
 98 
 
 99 
 101 
 275 
 322 
 322 
 323 
 324 
 325 
 328 
 327 
 328 
 331 
 331 
 331 
 338 
 338 
 339 
 341 
 342 
 342 
 343 
 364 
 375 
 375 
 381 
 387 
 389 
 391 
 395 
 396 
 407 
 
 19 
 23 
 
540 
 
 INDEX. 
 
 Error relative to extra food for pregnant women, &c. 
 Exercise, to the extent of causing fatigue, to be avoided 
 Exceptions to the rule relative to suckling, very few 
 Exposure and hardening of children . 
 
 general observations 
 
 danger of exposing infants to cold and damp 
 
 anecdotes respecting 
 
 danger of too great delicacy of treatment 
 Exercise for young children 
 
 carrying in the arms 
 
 walking ..... 
 
 general observations on other modes . 
 
 riding in a carriage 
 on horseback 
 
 games of various kinds 
 
 dumb-bells .... 
 Erysipelas ..... 
 
 time of attack and part of body affected 
 
 stages of the disease 
 
 treatment .... 
 
 Ear, abscess within the .... 
 
 F. 
 
 Females may be ineligible for marriage from various causes 
 Fulness of the head in pregnancy, how to be avoided 
 Fcetus, membranes, and weight of 
 Food, dictates of nature relative to quantity of 
 proper for pregnant woman 
 
 Food 
 
 causes which may render it improper for the mother 
 to nurse ..... 
 
 proper for children after first dentition and weaning 
 
 care to be taken that permanent dislikes to certain 
 
 food are not formed .... 
 
 are there substances in common use absolutely hurt- 
 ful to children? .... 
 
 fruit in general ..... 
 
 fresh fruit 
 
 dried fruit . . . . ... 
 
 Feeding the child in the month 
 
 substitute for mother's milk 
 injurious effects of pap during the month 
 mode for preparing substitute for mother's milk 
 general rules as regards 
 Feelings, distressing, caused to a mother by recollection of 
 her neglect ..... 
 
 Flannel absolutely necessary in winter orin cool weather 
 error relative to dirty .... 
 
 protection afforded by, in variable weather 
 may be improper for various reasons 
 belly-band should be of 
 fashion ..... 
 
 danger of exposure of arms of children 
 Fire, great care to be taken to prevent accidents from to 
 children ..... 
 
 G. 
 
 Galen's opinion of the power of the imagination, &c. 
 Gossipping stories injurious to pregnant women 
 
 productive of abortion . 
 Glas3 not to be introduced into nursery, if possible 
 
 Par. 
 
 40 
 111 
 136 
 
 460 
 
 464 
 469 
 
 478 
 
 761 
 
 778 
 785 
 786 
 792 
 
 954 
 957 
 959 
 
 23 
 39 
 44 
 45 
 
 489 
 
 720 
 
 734 
 735 
 
 758 
 247 
 248 
 249 
 252 
 339 
 
 85 
 208 
 209 
 211 
 213 
 216 
 
 458 
 
 387 
 
 61 
 
 87 
 
 88 
 
 390 
 
INDEX. 
 
 541 
 
 H. 
 
 Hereditary complaints, tendency to, to be investigated 
 Health, immediate state of, defined 
 
 why disregarded by parties concerned 
 Habits, bad, objections to marriage 
 
 Hunter, Dr., experiments and conclusions on the power of 
 imagination . ' . 
 
 singular case related, and left unaccounted for by . 
 Highly injurious effects of stimulating drinks 
 Hydrocele .... 
 
 diagnosis . 
 
 treatment .... 
 Hernia, umbilical .... 
 
 nurse not to be blamed for this complaint 
 
 to be attended to as early as possible . 
 
 treatment 
 Hernia, inguinal .... 
 
 symptoms .... 
 
 Dr. Underwood's opinion erroneous 
 
 Dr. Physick's plan of treatment 
 Hip joint, abscess of . 
 
 not perceived or attended to early . 
 
 modeof detection, and symptoms 
 
 mode of treatment . 
 
 curved splint ..... 
 
 I. 
 
 Instances of longevity ..... 
 
 Intoxication after marriage, unfortunate frequency of 
 Injury to child in utero from causes insufficient to produce 
 abortion ... ... 
 
 Imagination has no influence on the unborn child 
 
 origin of the belief in the powers of 
 
 prejudices on the subject of, difficult to remove 
 
 general opinion among the ancients as to its power 
 Important duties of a pregnant woman 
 Indiscriminate use of laudanum and the lancet reprehended 
 Intention, the test of criminality, in cases of neglect 
 Is every woman capable of nursing? . 
 Injuries, physical, caused by deficiency of milk 
 
 from bad milk ..... 
 
 from want of care, &c. .... 
 
 from selfishness of nurses . . . 
 
 from propagation of an occult or active disease 
 Jaundice ...... 
 
 symptoms, &c. ..... 
 
 whether communicable from milk of mother or nurse 
 
 treatment ...... 
 
 L. 
 
 Longing ... . 
 
 singular instances of ... . 
 
 disappointment of, not to be dreaded . 
 
 Labour, risk of diminished by presence of good medical aid 
 commencement of, s never to be interfered with 
 arguments against despondency during a first 
 general rules to be observed at the period of . 
 
 Laudanum, artfully used by selfish nurses 
 
 detection of a nurse in the clandestine use of . 
 
 Par. 
 
 Page. 
 
 14 
 
 22 
 
 18 
 
 23 
 
 19 
 
 23 
 
 21 
 
 24 
 
 72 
 
 39 
 
 74 
 
 40 
 
 80 
 
 42 
 
 
 352 
 
 1171 
 
 352 
 
 1172 
 
 353 
 
 
 353 
 
 1175 
 
 354 
 
 1178 
 
 354 
 
 1179 
 
 354 
 
 
 355 
 
 1181 
 
 355 
 
 1182 
 
 355 
 
 1183 
 
 355 
 
 
 356 
 
 1185 
 
 356 
 
 1187 
 
 356 
 
 1189 
 
 357 
 
 1193 
 
 358 
 
 9 
 
 20 
 
 22 
 
 24 
 
 34 
 
 27 
 
 55 
 
 33 
 
 56 
 
 34 
 
 59 
 
 35 
 
 60 
 
 35 
 
 84 
 
 43 
 
 114 
 
 50 
 
 138 
 
 57 
 
 149 
 
 61 
 
 155 
 
 63 
 
 156 
 
 63 
 
 159 
 
 64 
 
 161 
 
 65 
 
 170 
 
 68 
 
 
 289 
 
 932 
 
 289 
 
 939 
 
 290 
 
 942 
 
 291 
 
 46,51 
 
 32,33 
 
 48 
 
 32 
 
 52 
 
 33 
 
 108 
 
 48 
 
 113 
 
 50 
 
 116 
 
 51 
 
 317 
 
 105 
 
 164 
 
 65 
 
 166 
 
 66 
 
542 
 
 INDEX. 
 
 never to be administered but by mother or some 
 trusty person ..... 
 Labia pudendi, adhesion of, in children 
 
 importance of early attention to 
 treatment .... 
 
 M. 
 
 Marriages, too early, not approved of . 
 
 judicious, combined with proper physical education, 
 
 best preventive of hereditary diseases 
 why not to be long- deferred by females 
 why not to be entered into by very young girls 
 Modes in which the imagination is supposed to act on the 
 fetus ...... 
 
 Marks, certain, may be hereditary % . . . 
 
 Milk fever, an artificial condition produced by errors in 
 
 diet ....... 
 
 Moral injuries caused by nurses 
 
 Materials of children's dresses to be suited to the season 
 
 Milk posset, how to be made .... 
 
 Molasses posset ...... 
 
 Mother, general rules for conduct after birth of child 
 Milk of mother, general rules respecting . 
 Meconium, of the, and management . 
 
 to derive advantage from it, child must be applied 
 to the breast early .... 
 
 purging off the meconium of moment, but drastic 
 
 purges not to be used 
 proper remedies to be used 
 observations on . . . . 
 
 case of disease from retention of . 
 
 N. 
 Notions, ridiculous, relative to the power of the mother's 
 
 imagination ...'.. 
 
 Nature of the connexion existing between mother and child 
 Nipples, cause of sore .... 
 
 means of preventing soreness of . 
 injured by compression 
 how to bring out when imperfect . 
 Nurses, their selfish tricks exposed 
 
 too much confidence reposed in their judgment 
 duties as regards physicians 
 Nursing, important rules relative to 
 
 partial or artificial .... 
 only reasons for .... 
 present a choice of means 
 
 1. Means where mother may continue to nurse 
 substitute for milk, and mode of giving 
 age proper for change of diet, and rules respect 
 
 ing 
 child not to be permitted to sleep at the breast 
 use of butter, &c. .... 
 
 2. Where artificial means must be used exclusively 
 feeding from the bottle .to be preferred to the 
 
 spoon, and rules 
 analysis of milk of different animals 
 general rules as to feeding child 
 mode of preserving milk in a proper condition 
 
 Par. 
 511 
 
 120S 
 1213 
 
 15 
 
 24 
 
 25 
 
 62 
 70 
 
 117 
 
 173 
 
 200 
 
 323 
 347 
 
 498 
 
 499 
 501 
 
 927 
 
 62 
 64 
 125 
 126 
 130 
 131 
 
 503 
 505 
 511 
 
 520 
 520 
 
 521 
 
 529 
 536 
 539 
 
 544 
 563 
 566 
 573 
 
INDEX. 
 
 543 
 
 Par. Page, 
 
 Rousseau's opinion as regards milk . . 581 178 
 3. Means or employment of a wet nurse . 180 
 general observations .... 588 180 
 requisites in a nurse, &c. . . . 595 182 
 mother should assume all duties but that of suck- 
 ling . .- . . 610 187 
 if child be sent away, to be placed in the coun- 
 try 617 190 
 
 Nursing, drinks for a child ... . . 620 191 
 
 Nursery, of the - . . . . . 108 
 
 rules for choice of nursery, and plan . . 352 108 
 
 should be carpeted .... 357 109 
 
 mattresses to be preferred to feather beds . . 360 110 
 
 early and late rising, observations on . . 365 111 
 
 cradles, advantages of, and observations on . 371 112 
 
 mode of warming .... 374 113 
 
 amusements for children in . . . 378 114 
 accidents children are liable to . . 387 116 
 ventilation to be strictly attended to, and rules re- 
 specting ..... 391 117 
 
 children never to be left alone, or animals to be left 
 
 with them ..... 396 118 
 
 rules as to lights ..... 398 119 
 
 Nourishment proper for child .... 159 
 
 milk, of mother to be preferred . . . 513 159 
 child not to be subjected to laws of nursing till six 
 
 months of age . . . . . 516 160 
 
 rules to be followed after sixth month . . 516 160 
 
 Needles not to be employed in place of pins . . 240 86 
 
 case of serious injury from . . . 241 87 
 
 Necessities of new-born children .... 416 125 
 
 Navel-string, bleeding from .... 349 
 
 should be occasionally watched *. . A . i 1158 349 
 
 causes . . . . . . 1159 349 
 
 curious case of bleeding from navel-string . 1160 350 
 
 practical cautions .... H63 350 
 
 ulceration, or imperfect healing of . . 351 
 
 exhibits three different conditions . . 1166 351 
 
 treatment of each ..... 351 
 
 O. 
 
 Officiousness of ignorant practitioners and midwives, in- 
 juries caused by . . . . . 109 49 
 
 Observances towards the mother during the month . 93 
 great cleanliness to be observed . . . 263 93 
 importance of free ventilation . . . 264 93 
 how soon a woman may venture abroad with safe- 
 ty after confinement . . . 266 94 
 importance of proper exercise . . . 270 95 
 towards child from second dentition to puberty 254 
 eating . . , . . . " . 851 255 
 drinking ..... 865 258 
 
 sleeping . . . . . . 866 258 
 
 exercise ..... 874 259 
 
 Ophthalmia . 314 
 
 symptoms and causes .... 1019 314 
 
 prevention and treatment .... 1025 315 
 
 Dr. Underwood's description unsatisfactory, &c. 1027 316 
 
 astringent lotions not to be used early . . 1030 316 
 
 treatment ..... | 1032 317 
 
544 
 
 INF] 
 
 P. 
 
 Period of life at which the. body is matured 
 
 not to be precisely fixed by lapse of time 
 Pregnancy does not necessarily require the use* of the 
 lancet . . . . 
 
 appetite for food not to be excessively indulged 
 during ..... 
 
 Period at which the imagination is supposed to act upon 
 
 the fcetus undetermined 
 Popular error relative to " keeping up the strength " 
 Pins, too many used in dressing infants 
 Pertussis, or hooping-cough 
 
 symptoms .... 
 
 duration of complaint 
 
 pathology of 
 
 origin : 
 
 various writers on, note 
 
 considered as essentially inflammatory, by Drs 
 Watt, Desruelles, Laennec, &c. 
 
 opinion of Desruelles 
 
 most severe in infants .... 
 
 treatment ..... 
 
 bleeding in, opposed by Burton and Millar 
 
 absolutely necessary in many instances 
 
 the plans of treatment'of Willis, Sydenham, &c. 
 
 not of opinion it is caused by cerebral inflammation 
 
 observations as to the determined course of the d» r 
 ease ..... 
 
 danger of opinion that the disease cp r»f"»* be short 
 ened ..... 
 
 defence of author's mode of treao nt against 
 
 the attack of Desruelles 
 
 use of bark in . 
 
 Sutcliffe's plan in . 
 
 change of residence 
 Prolapsus ani . 
 
 causes . . . 
 
 symptoms ..... 
 
 to prevent constriction 
 
 mode of reduction . 
 
 Dr. Underwood's opinion 
 
 prevention, Dr. Physick's plan 
 
 R. 
 
 Reasons why pregnant women should avoid too much ex 
 
 ercise 
 Remedies which contribute most to the improvement of 
 
 the milk ..... 
 Rules to prevent abortion . 
 
 for conduct during labour 
 
 after the birth of the child 
 as regards nursing . 
 
 dressing child 
 to be observed by nurse after weaning child 
 Room proper for purposes of a nursery 
 Rocking horse as an appendage to a nursery . 
 Respiration, want of, -&c. in new-born children . 
 
 premature tying the cord often' injurious to the 
 
 child .... 
 
 Mr. Burns' opinion 
 
 Par. 
 
 41 
 
 42 
 
 67 
 115 
 
 238 
 
 1448 
 1452 
 1453 
 1454 
 
 1462 
 1463 
 1460 
 1465 
 1466 
 1467 
 1468 
 1476 
 
 1452 
 
 1485 
 1481 
 1501 
 1495 
 1497 
 1505 
 
 1762 
 1763 
 1764 
 1765 
 1768 
 1769 
 
 110 
 
 290 
 292 
 320 
 323 
 326 
 330 
 652 
 351 
 370 
 
 885 
 886 
 
 Pagt 
 
 18 
 
 18 
 
 29 
 
 30 
 
 50 
 85 
 427 
 427 
 428 
 429 
 431 
 431 
 
 434 
 434 
 433 
 435 
 436 
 436 
 436 
 439 
 
 428 
 
 441 
 440 
 445 
 444 
 444 
 447 
 523 
 523 
 523 
 523 
 524 
 524 
 525 
 
 49 
 
 101 
 102 
 105 
 105 
 105 
 106 
 201 
 108 
 115 
 275 
 
 275 
 276 
 
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 I ■ ... i ■ • ■ Jft « , ■ n 
 
 
 
 I 
 
 M 
 
 
 
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 V/Vi 
 
 
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